Black Esophagus After Bile Duct Injury: A Case Report of Acute Esophageal Necrosis
DOI:
https://doi.org/10.37497/JMRReview.v5i00.1485Keywords:
Acute esophageal necrosis, Black esophagus, Bile duct injury, Cholecystectomy, Upper gastrointestinal bleedingAbstract
Background: Acute esophageal necrosis, also known as black esophagus, is a rare and potentially life-threatening condition characterized by circumferential necrosis of the esophageal mucosa, generally associated with systemic hypoperfusion and chemical injury caused by gastric reflux. Its most common clinical manifestation is upper gastrointestinal bleeding, particularly in elderly patients with severe underlying conditions. The occurrence of this complication following an iatrogenic bile duct injury represents an unusual clinical scenario requiring early diagnosis and multidisciplinary management.
Aim: To report a case of acute esophageal necrosis following an iatrogenic bile duct injury during laparoscopic cholecystectomy, highlighting the clinical and endoscopic findings, therapeutic interventions, and patient outcomes.
Methods: This descriptive case report was based on the analysis of the clinical course of a 78-year-old female patient who developed acute esophageal necrosis following laparoscopic cholecystectomy complicated by a bile duct injury. Clinical findings, imaging examinations, endoscopic procedures, surgical interventions, therapeutic management, and outcomes during hospital follow-up were evaluated.
Results: A 78-year-old female patient presented with severe abdominal pain, vomiting, and hematemesis on the fifth postoperative day following laparoscopic cholecystectomy. Computed tomography revealed free intraperitoneal fluid, and diagnostic laparoscopy identified biliary peritonitis associated with an injury to the duct of Luschka, classified as Strasberg type A, as well as choledocholithiasis. Upper gastrointestinal endoscopy demonstrated extensive circumferential necrosis of the esophageal mucosa, consistent with acute esophageal necrosis. Initial management included fasting, nutritional support, proton pump inhibitor therapy, and abdominal drainage. Follow-up endoscopy showed no evidence of perforation. However, approximately two weeks later, the patient developed oral feeding intolerance and vomiting, and cicatricial esophageal stenosis was identified. Continued enteral nutritional support was required, followed by exploratory laparotomy with choledochotomy, papillosphincteroplasty, and gastrostomy. Subsequently, endoscopic esophageal dilation was initiated, with favorable clinical recovery.
Conclusion: Acute esophageal necrosis should be considered in patients presenting with upper gastrointestinal bleeding following surgical complications associated with systemic hypoperfusion and intra-abdominal inflammation. Early endoscopic diagnosis, clinical and nutritional support, and definitive management of the underlying biliary injury are essential for treating this condition. In this case, despite the development of esophageal stenosis, multidisciplinary management resulted in favorable clinical outcomes, highlighting the importance of serial endoscopic follow-up for the identification and treatment of late complications.
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