New York University Langone Medical Center New York, NY, United States
Moniyka Sachar, MD1, Erick Argueta, MD2, Zilla Hussain, MD2 1New York University Langone Medical Center, New York, NY; 2Warren Alpert Medical School of Brown University, Providence, RI
Introduction: Acute esophageal necrosis (AEN) presents as hematemesis, coffee-ground emesis, melena, or epigastric pain, with the majority of patients in septic shock or multiple organ dysfunction. Acute gastric volvulus (AGV) is an even rarer condition with unknown prevalence. Only two other case reports have ever described the co-occurrence of AEN and AGV, with both presentations were in hemodynamically unstable patients requiring surgical management. To our knowledge, this is the first reported case presentation of medically managed AEN in the setting of AGV.
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Case Description/Methods: A 71 year-old female with a history of chronic hiatal hernia, normocytic anemia, type 2 diabetes mellitus, and hypertension was admitted to the hospital after a routine outpatient endoscopy, scheduled to help elucidate the etiology of her anemia, revealed esophageal necrosis. She reported coincidental severe epigastric pain that began on the morning of outpatient endoscopy. However, she denied epigastric pain or other gastrointestinal symptoms prior to that morning. On endoscopy, she was found to have circumferential, middle-to-distal esophageal necrosis at 29-33 cm with a large hiatal hernia extending from 33-43 cm (Figure 1). Given the extent of her esophageal necrosis, inpatient admission was recommended. Upon presentation, vitals and laboratory results were unrevealing. A CT was obtained which was notable for a hiatal hernia in organo-axial configuration (Figure 1). Given her hemodynamic stability, no surgical intervention was pursued. She was started on a proton pump inhibitor twice daily. A repeat upper endoscopy and surgical correction of her hernia to prevent recurrence was scheduled at the time of discharge.
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Discussion: This patient displayed an atypically hemodynamically stable presentation of AEN. Further, AEN with concomitant AGV is extremely rare with only two other documented case reports. In contrast to this patient, one patient presented with hemodynamic shock and the other with acute GI bleeding. Both were successful operatively managed with partial esophagectomy, partial gastrectomy and anastomosis. In similarity to this patient, both previously reported cases were in females older than 70 years with chronic hiatal hernia. Despite our patient’s unique presentation, her incidental routine endoscopy may have contributed to the timely identification and medical management of her rare condition.
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Figure: Esophagogastroduodenoscopy showing (A) ulceration and (B) circumferential middle-to-distal esophageal necrosis at 29 - 33 cm. Computed tomography without contrast showing (C) intrathoracic gastric herniation with organo-axial volvulus and (D) distal esophageal thickening.
Disclosures: Moniyka Sachar indicated no relevant financial relationships. Erick Argueta indicated no relevant financial relationships. Zilla Hussain indicated no relevant financial relationships.
Moniyka Sachar, MD1, Erick Argueta, MD2, Zilla Hussain, MD2. P0343 - Acute Esophageal Necrosis in the Setting of Gastric Volvulus and Hemodynamic Stability, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
