Incidence of oesophageal necrosis in an autopsy material

The incidence of oesophageal necrosis was studied in 310 consecutive autopsies of patients more than 2 years old. The oesophagus and upper part of the stomach were excised and formalin-fixed in all cases suspicious of necrosis. Suspicious areas were taken out for microscopy. The necroses presented as dark coloured or black, punctate, striped or confluent areas, most frequently located in the lower third of the organ and usually stopping abruptly at the cardia. They were distinguished from autolytic changes by the presence of a vital reaction (i.e. fibrin exudation and presence of neutrophils). Necroses were observed in 32 of the 310 patients. In nine patients the necrosis extended into or through the muscularis propria. In 13 patients there was only mucosal necrosis. In the remaining cases the necroses extended into the submucosa. In one patient the necrosis caused fatal bleeding. We believe that oesophageal necrosis is a change which is often overlooked - whether presenting at endoscopy or at autopsy - and that the condition should be taken seriously as a cause of possible bleeding, perforation or septicemia. The cause is not firmly established, but the present as well as earlier works point to acid reflux combined with hypoperfusion as important pathogenetic factors.