Acute Esophageal Necrosis Secondary to Cardiogenic Shock: A Case Report and Review of the Literature

Acute esophageal necrosis (AEN), also known as "black esophagus," is an uncommon clinical entity characterized by diffuse, circumferential, dark pigmentation of the esophageal mucosa. Its pathogenesis is explained by a "two-hit" mechanism involving systemic hypoperfusion and local chemical injury from gastric acid. We present the case of a 78-year-old man with a history of hypertension, diabetes, and a recent anteroseptal myocardial infarction complicated by cardiogenic shock, requiring triple stent placement and vasopressor support. One week after discharge, the patient was readmitted due to hematemesis and hemodynamic instability. Upper gastrointestinal endoscopy revealed extensive necrotic tissue in the distal third of the esophagus, ending abruptly at the gastroesophageal junction. A thoracoabdominal computed tomography scan confirmed esophageal wall thickening but ruled out perforation. Management was strictly conservative, consisting of total parenteral nutrition for esophageal rest, aggressive acid suppression with intravenous proton pump inhibitors, and optimization of cardiac output. A follow-up endoscopy performed seven days later showed complete resolution of the necrotic lesions. Although AEN carries a high overall mortality rate, death is usually attributed to underlying comorbidities rather than esophageal complications. This case highlights that prompt stabilization of the triggering hemodynamic event, combined with conservative medical therapy, allows for rapid mucosal recovery and prevents the need for invasive surgical intervention.