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BLACK ESOPHAGUS AND GASTRIC ISCHEMIA; THIS IS NO PROBLEM TO SLEEP ON
A Choudhry, S Cavanaugh, M Crye, M Archer, J Wallen
SUNY Upstate Medical University

Background
Acute Esophageal Necrosis (AEN) or “black esophagus” is a rare clinical condition that commonly presents as a circumferential black discoloration at the distal esophagus that abruptly stops at the GE junction. Although it can resolve with medical management at times, late presentation or a delay in management can lead to mortality as high as 31%. We present a case of a patient who presented with Acute Esophageal Necrosis and its expected management.

Methods
A 58-year-old male presented to the hospital after 2 to 3 days of nausea and vomiting after being discovered down and unresponsive. He was intubated for unresponsiveness and on arrival to the hospital, he was hypothermic and hypotensive with a WBC of 33. Imaging was concerning for an esophageal perforation however when the patient was taken to the operating room and an endoscopy was performed (IMAGE 1) he was noted to have a necrotic esophagus.

Results
The patient underwent an esophagectomy with diverting esophagostomy, G and J-tube placement however had a postoperative complication of gastric ischemia necessitating a subtotal gastrectomy. This created a challenge for the recreation of an esophageal conduit at a later time.

Conclusion
In this case, we discuss the interesting presentation of acute esophageal necrosis and gastric ischemia. How the patient was managed and plans for recreation of an esophageal conduit.


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