Black esophagus: the only clue
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LETTER TO THE EDITOR
Black esophagus: the only clue Grigoriy E. Gurvits
Published online: 10 June 2011 Ó Springer Science+Business Media, LLC 2011
I read with great interest the article by Tsokos on black esophagus [1]. The author describes a case of acute esophageal necrosis (AEN) in a previously healthy 64-year-old man who he believes succumbed to hemorrhagic shock caused by black esophagus and duodenal ulcerations. Although AEN can initially present with gastrointestinal bleeding and is associated with high mortality (around 30%) from underlying medical conditions, death secondary to esophageal disease (perforation, mediastinitis, and esophageal infection in an immunocompromised individual) is seen in less than 6% of patients [2]. The finding of an isolated black esophagus in a healthy patient without the above pathological findings raises the question of whether AEN
was only a clue to another catastrophic event that went unnoticed such as a cardiac arrhythmia. I would suspect that an undiagnosed run of ventricular fibrillation was the cause of death in this patient with secondary black esophagus.
References 1. Tsokos M. Black esophagus. Forensic Sci Med Pathol. 2011. doi:10.1007/s12024-011-9222-0. 2. Gurvits GE, Shapsis A, Lau N, Gualtieri N, Robilotti JG. Acute esophageal necrosis: a rare syndrome. J Gastroenterol. 2007;42: 29–38.
G. E. Gurvits (&) Division of Gastroenterology, New York University School of Medicine, 530 First Ave SKI—9N, New York, NY 10016, USA e-mail: [email protected]
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