[Hemorrhagic necrosis of the esophagus]

A series of 25 necropsy patients aged 54-95 y. with hemorrhagic necrosis of the esophagus presented by black mucosa were studied. The discoloration was diffuse in most cases; less frequently there were black longitudinal streaks corresponding with mucosal folds. In 16 cases, the lesion affected the entire esophagus, in the remaining cases only the distal half to third of esophagus was affected. The changes ended abruptly at the cardia. Histologically, there was necrosis of the mucosa with focal involvement of muscularis mucosae. The necrotic tissue was usual densely infiltrated by leucocytes. The submucosa showed edema, fibrinorrhagy and slight hemorrhage. There were platelet thrombi in small mucosal and submucosal vessels. In only some cases, the infiltrate affected the entire muscularis propria. Gastrointestinal bleeding was noted in 8 cases. The esophageal lesion was preceded by circulation disorders, as shown in both the clinical course and in the autopsy findings. Local hypoperfusion, venous reflux, and gastroesophageal reflux appear as the principal pathogenetic factors.