Fatal black esophagus and duodenum

Area of Science:

• Forensic Pathology
• Gastroenterology

Background:

• Black esophagus (BE) is a rare endoscopic finding characterized by distal esophageal mucosal black discoloration.
• BE is frequently observed in forensic autopsies, often associated with diabetic ketoacidosis or hypothermia.
• Co-occurring acute duodenitis, termed 'black duodenum,' can also be present.

Purpose of the Study:

• To report a forensic autopsy case of a young male who died from black esophagus and black duodenum.
• To investigate the cause of death in the absence of typical predisposing factors such as diabetes or substance abuse.

Main Methods:

• Forensic autopsy and histopathological examination.
• Toxicological analysis of blood for alcohol and acetone levels.
• Assessment of hemoglobin A1c levels.

Main Results:

• The autopsy revealed significant black discoloration of the distal esophagus and duodenum, with hematinized fluid in the stomach.
• The patient had no history of diabetes or alcohol/drug abuse; blood acetone and HbA1c were within non-diabetic ranges.
• Cause of death was attributed to exsanguination secondary to bleeding from the black esophagus and duodenum.

Conclusions:

• Black esophagus and black duodenum can be life-threatening, leading to exsanguination and death.
• Forensic pathologists must consider BE as a potential cause of death, even in cases lacking typical underlying medical conditions.
• Esophageal mucosal injury from vomiting or ischemic insult due to dehydration may contribute to BE development.