Black esophagus.

Area of Science:

• Gastroenterology
• Vascular Medicine

Background:

• Cardiovascular disease is a significant risk factor for various medical emergencies.
• Peripheral arterial disease can indicate systemic vascular compromise.

Observation:

• A 76-year-old male with hypertension, type 2 diabetes mellitus, hyperlipidemia, and smoking history presented with coffee ground emesis and anemia.
• Physical examination revealed severe peripheral arterial disease, including prior iliofemoral bypass and supracondylar amputation.
• Urgent gastroscopy identified diffuse, circumferential black mucosa in the middle and distal esophagus, abruptly ending at the gastroesophageal junction.

Findings:

• The endoscopic findings are consistent with acute esophageal necrosis.
• This rare condition is characterized by a "black esophagus" appearance.
• The interruption at the gastroesophageal junction is a key diagnostic feature.

Implications:

• Acute esophageal necrosis should be considered in patients with cardiovascular risk factors presenting with upper gastrointestinal bleeding.
• Early diagnosis and management are crucial for improving patient outcomes.
• This case highlights the importance of considering esophageal pathology in patients with systemic vascular disease.