IDIOPATHIC ACUTE ESOPHAGEAL NECROSIS - NOT NECESSARILY A TERMINAL EVENT

Idiopathic acute esophageal necrosis (AEN) has been considered a rare event, usually having an ischemic origin. Primarily cases from autopsy studies have been reported. This report deals with 10 such cases whic h were diagnosed among some 80,000 esophago-gastroscopies performed du ring a 16-year period. Nine patients recovered and were discharged fro m the hospital. The esophageal lesions presented as a demarcated, blac k discoloration which usually evolved to a picture suggestive of unspe cific esophagitis. Histology invariably revealed diffuse and conspicuo us necrosis involving the mucosa, submucosa and, frequently, muscular layers. In 2 cases, esophageal stenosis developed and, in one case, a full-thickness necrosis made surgery with colon interposition mandator y. Hyperglycemia, hypoxia, carcinoma and ischemic phenomena were found as associated conditions. Gastroduodenal, acute ulcerative disease wa s present in four patients. From this experience, it is concluded that AEN is not necessarily a terminal phenomenon, notwithstanding that it is usually associated with pre-existent serious illness. Nevertheless , its etiology remains unknown.