A Case of Esophageal Stenosis due to Acute Esophageal Necrosis which was Treated by Esophagectomy with Great Difficulties

Abstract

Acute esophageal necrosis (AEN), which presents as a black esophageal mucosa on endoscopy, is a rare disease. The prognosis is favorable, but sometimes AEN is associated with esophageal stenosis that can make the treatment difficult. Since the AEN patients often have underlying diseases including diabetes mellitus as background factors, their surgical therapies for esophageal stenosis entail a high risk of causing perioperative complications. The case involved a 72-year-old man who had previous histories of diabetes and cerebral infarction. During an upper gastrointestinal endoscopy, black mucosa affecting from the middle to lower thoracic esophagus was found, and it was diagnosed as AEN. Thereafter the black color of the esophageal mucosa was improved, however, esophageal stenosis accompanying remarkable cicatrization appeared. We inferred that no improvement could be expected from non-surgical treatments such as endoscopic balloon dilation (EBD) and then performed right trans-thoracic and abdominal subtotal esophagectomy. After the operation, we challenged the drainage for suture failure associated with partial necrosis of the reconstructed gastric tube and repeated EBDs for stenosis at the anastomosed site. Finally, the patient was cured of the disease that required a great deal of effort. In treating the patient with AEN associated with esophageal stenosis, the early intervention such as EBD should be carefully investigated.