Acute gastrointestinal necrosis: "black esophagus" or "black gut".

Acute gastrointestinal necrosis (AGN) can result from multitude of local or systemic factors. The distribution of necrosis is likely to depend on the site of the insult and/or the vascular supply of the affected bowel. A rare syndrome of “Acute esophageal necrosis” (AEN) or “Black esophagus” (BEs) has been described earlier referring to black discoloration of esophageal mucosa seen on endoscopic exam. The reported incidence of AEN is 0.008% to 0.2% and the etiology is assumed to be largely multifactorial. Ischemia has been proposed to be the commonest suspected cause of AEN, but the preferential involvement of esophagus despite having rich segmental and intramural blood supply needs further explanation. We herein, report a case of AGN presenting as black esophagus. With an extensive review of literature we have elucidated the risk factors, mechanisms of gut injury, clinical presentation, treatment options and prognosis of the syndrome.