ADVERTISEMENT

Black Esophagus: A Rare Cause of Gastrointestinal Hemorrhage in the Emergency Department

In this case presentation of a 65-year-old man who presented to the ED for evaluation of a 1-week history of intermittent coffee-ground emesis and syncope, the authors review the literature about a rare, but potentially fatal diagnosis.
Emergency Medicine. 2018 August;50(8):155-160 | 10.12788/emed.2018.0101
August 3, 2018|Emergency Medicine
Jason Arthur MD, MPH;Dave Caro, MD;Davis Lester, MD;Zachary Hester, MD;Valery Muenyi, MD
Author and Disclosure Information

Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Dr Arthur is an assistant professor and emergency ultrasound fellow, department of emergency medicine, University of Arkansas for Medical Sciences, Little Rock. Dr Caro is an associate professor and emergency medicine residency program director, department of emergency medicine, University of Florida College of Medicine, Jacksonville. Dr Lester is an emergency medicine resident physician, department of emergency medicine, University of Florida College of Medicine, Jacksonville. Dr Hester is an emergency medicine resident physician, department of emergency medicine, University of Florida College of Medicine, Jacksonville. Dr Muenyi is a gastroenterology fellow, department of medicine, division of gastroenterology, University of Florida College of Medicine, Jacksonville.

Esophageal strictures are the most common complication of black esophagus, developing in 16% to 25% of cases. Due to underlying disease, AEN is associated with a high-mortality of 12.5% to 36%.4,11 Mortality as a direct result of esophageal necrosis is less than 6%.10 Complications of black esophagus include perforation and mediastinitis, both of which are indications for emergent surgical intervention.1,15Emergency physicians traditionally manage GI bleeding with conservative measures and early involvement of gastroenterology services. Failure of patients to respond to traditional resuscitative measures may signal mediastinitis and require immediate surgical intervention. This infrequent diagnosis represents a significant deviation from the typical presentations seen by EPs in standard practice; for this reason, EPs should be aware of the signs and symptoms associated with black esophagus and consider it in the differential diagnosis of patients presenting with GI bleeding.

Summary

Emergency physicians are often the first providers to care for patients with an upper GI hemorrhage. While the mainstay of treatment of hematemesis is resuscitation with intravenous fluids and blood products, EPs must be aware of the potential etiologies that may change management. Black esophagus is a rare but important cause of hematemesis—a condition that can lead to esophageal perforation and mediastinitis. In cases wherein patients fail to respond to appropriate resuscitation, subsequently decompensate despite resuscitation, or appear septic, EPs should consider IV broad-spectrum antibiotics and surgical consultation.

ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT