Acute Necrotizing Esophagitis Following a 44-Hour Refractory Food Bolus Impaction

We report a rare case of acute necrotizing esophagitis (ANE) that developed following prolonged food bolus impaction. A 52-year-old man with a history of depression and nearly complete edentulism, but no other comorbidities, presented with acute dysphagia after ingesting a large piece of pork. Endoscopy revealed a meat bolus tightly impacted in the thoracic esophagus, with no visible lumen. Multiple endoscopic retrieval attempts using snares, retrieval nets, and dissection devices were unsuccessful due to the bolus's large size and dense, fatty consistency. Ultimately, repeated blunt fragmentation using alligator forceps allowed dislodgment into the stomach. Endoscopic examination after removal revealed circumferential black discoloration and mucosal edema, consistent with ANE, confined to the proximal side of the obstruction. The patient was managed conservatively with bowel rest (nil per os, NPO) and intravenous fluids, and follow-up endoscopy on hospital day 7 showed marked mucosal improvement. He resumed oral intake without complications and was discharged on hospital day 9. This case highlights that prolonged refractory esophageal obstruction for 44 hours, even without systemic comorbidities, can lead to ANE through localized ischemia and mechanical stress. Prompt recognition and timely intervention are essential to prevent serious complications.