Acute Esophageal Necrosis in a Patient With Severe Cardiovascular Disease and Arrhythmia

Acute esophageal necrosis is a gastrointestinal syndrome characterized by diffuse, circumferential, black-appearing mucosa of the distal esophagus and involves various lengths. It is a multifactorial condition involving hypoperfusion from a low flow state, large reflux of gastric contents, and a poor mucosal barrier. Complications involve esophageal stenosis or stricture and esophageal perforation. Treatment is often supportive with correction of underlying conditions, aggressive fluid resuscitation, antacid therapy, and restriction of oral intake. We present an unusual case of black esophagus in a patient with significant cardiovascular disease and rhabdomyolysis and discuss its pathogenesis, management, and outcome.