Black oesophagus in a patient with peritoneal carcinomatosis

Acute oesophageal necrosis (AEN) is a rare disorder that presents like “black oesophagus” on endoscopy. The main risk factors include age, male sex, cardiovascular disease, gastric outlet obstruction, diabetes, malnutrition and alcohol ingestion. Malignancy is associated to AEN in about 20% of cases. Case Report: A 78-year-old man presented with ascites, anorexia, nausea and weight loss. His alcohol intake was about 50 g daily and he had hypertension, ischemic cardiopathy and chronic obstructive pulmonary disease. Laboratory and imaging investigations oriented towards biliary malignancy with peritoneal carcinomatosis. Twenty days after admission, the patient had an episode of hematemesis. At upper gastrointestinal endoscopy, the entire oesophagus was black with superimposed pseudomembranes. Additional fi ndings included cardial and duodenal ulcers with pyloric involvement. After treatment with omeprazole and parenteral nutrition, the endoscopic fi ndings disappeared but the patient died in two weeks because of malignant cachexia. Conclusions: AEN should be considered in the differential diagnosis of upper gastrointestinal bleeding. Malnutrition in malignancy, together with other risk factors, fi rst of which cardiovascular disease and gastric outlet obstruction, can contribute to mucosal necrosis.