Black Esophagus After Bile Duct Injury: A Case Report of Acute Esophageal Necrosis
DOI:
https://doi.org/10.37497/JMRReview.v5i00.1485Palavras-chave:
Necrose esofágica aguda, Esôfago negro, Lesão da via biliar, Colecistectomia, Hemorragia digestiva altaResumo
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.
Referências
Brar TS, Helton R, Zaidi Z. Total parenteral nutrition successfully treating black esophagus secondary to hypovolemic shock. Case Rep Gastrointest Med. 2017;2017:4396870. doi: 10.1155/2017/4396870
Dias E, Santos-Antunes J, Macedo G. Diagnosis and management of acute esophageal necrosis. Ann Gastroenterol. 2019;32(6):529-540. doi: 10.20524/aog.2019.0418
Dias E, Santos-Antunes J, Rodrigues-Pinto E, et al. Risk factors and clinical outcomes of acute esophageal necrosis: retrospective case series of a rare disease with "black" prognosis. Acta Gastroenterol Belg. 2022;85(1):97-101. doi: 10.51821/85.1.9793
Field Z, Kropf J, Lytle M, et al. Black esophagus: a rare case of acute esophageal necrosis induced by diabetic ketoacidosis in a young adult female. Case Rep Gastrointest Med. 2018;2018:7363406. doi: 10.1155/2018/7363406
González Díaz I, Moreno-Sánchez M, Zarauza Soto Y, Burgos Garcia A. Black esophagus. Rev Esp Enferm Dig. 2023;115(11):646-647. doi: 10.17235/reed.2022.9217/2022
Gurvits GE. Black esophagus: acute esophageal necrosis syndrome. World J Gastroenterol. 2010;16(26):3219-3225. doi: 10.3748/wjg.v16.i26.3219
Gurvits GE, Cherian K, Shami MN, et al. Black esophagus: new insights and multicenter international experience in 2014. Dig Dis Sci. 2015;60(2):444-453. doi: 10.1007/s10620-014-3382-1
Lamers CR, Mares WGN, Bac DJ. Black esophagus: a case series and literature review of acute esophageal necrosis. Scand J Gastroenterol. 2018;53(10-11):1421-1424. doi: 10.1080/00365521.2018.1513064
Messner Z, Gschwantler M, Resch H, Bodlaj G. Use of the Ella Danis stent in severe esophageal bleeding caused by acute necrotizing esophagitis. Endoscopy. 2014;46(Suppl 1):E225-E226. doi: 10.1055/s-0034-1365762
Rigolon R, Fossà I, Rodella L, Targher G. Black esophagus syndrome associated with diabetic ketoacidosis. World J Clin Cases. 2016;4(3):56-59. doi: 10.12998/wjcc.v4.i3.56
Thomas M, Sostre Santiago V, Suhail FK, et al. The black esophagus. Cureus. 2021;13(10):e18655. doi: 10.7759/cureus.18655
Unuma K, Harada K, Funakoshi T, Uemura K. Sudden death of an alcoholic elderly man with acute esophageal necrosis (black esophagus). Forensic Sci Int. 2011;212:e15-e17. doi: 10.1016/j.forsciint.2011.06.001
Venara A, Pavageau AH, Maillart CR, Jousset N. Sudden death due to black esophagus: a case report. Am J Forensic Med Pathol. 2013;34(1):16-17. doi: 10.1097/PAF.0b013e318287a568
