Acute necrotizing esophagitis (black esophagus): An autopsy case with alcoholic ketoacidosis

Acute necrotizing esophagitis (black esophagus) is a rare but often fatal disease that is unexpectedly identified during postmortem examination. Forensic pathologists need to know its characteristic pathologic findings of this disease, and postmortem laboratory test results of patients suspected with acute necrotizing esophagitis should be determined. Here a case of a man who was found dead and diagnosed with acute necrotizing esophagitis after postmortem examination is presented. The mucosa of the lower esophagus was black until the gastro-esophageal junction, and a coffee-ground colored fluid was noted in the stomach, small intestine, and ascending colon. On microscopic examination, brown pigmentation was observed on the mucosa, and acute inflammation and necrosis were also identified in the esophageal wall. Furthermore, various laboratory tests performed using postmortem samples revealed ketoacidosis and renal dysfunction. To date, the pathogenesis and mechanisms of death due to acute necrotizing esophagitis are unclear. This report presents the characteristic pathologic findings and postmortem laboratory test results of acute necrotizing esophagitis. Especially hypovolemic shock and alcoholic ketoacidosis are suggested as a mechanism of death due to this disease.