Endoscopy 2020; 52(05): E181-E182
DOI: 10.1055/a-1059-9268
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Gurvitis syndrome: the dark shade of hematemesis

Cătălina Diaconu
1   Department of Gastroenterology, Clinical Emergency Hospital Bucharest, Bucharest, Romania
2   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,
Mihai Ciocîrlan
2   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3   Department of Gastroenterology, Agrippa Ionescu Hospital, Bucharest, Romania
,
Mădălina Ilie
1   Department of Gastroenterology, Clinical Emergency Hospital Bucharest, Bucharest, Romania
2   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,
Vasile Sandru
1   Department of Gastroenterology, Clinical Emergency Hospital Bucharest, Bucharest, Romania
,
Daniel Vasile Balaban
2   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
4   Department of Gastroenterology, Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
,
Oana Plotogea
1   Department of Gastroenterology, Clinical Emergency Hospital Bucharest, Bucharest, Romania
2   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,
Mircea Diculescu
2   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
5   Department of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania
› Author Affiliations
Further Information

Corresponding author

Mihai Ciocîrlan, MD, PhD
Department of Gastroenterology
“Agrippa Ionescu” Hospital
Ion Mincu no 7
PC 011356, Bucharest
Romania   

Publication History

Publication Date:
02 December 2019 (online)

 

Gurvitis syndrome, also known as acute esophageal necrosis (AEN) or “black esophagus,” is a rare syndrome characterized by necrotic lesions affecting the mucosa and submucosa, mainly in the distal part of the esophagus. Prevalence is 0.2 % and incidence is 0.01 % – 0.0125 % among Caucasians [1] [2].

A 63-year-old man who was a chronic smoker presented with a 12-hour history of hematemesis, increased abdominal girth, and weight loss (5 kg in the previous month). His medical history included biopsy-proven tubular adenocarcinoma liver metastases of unknown origin, which had been diagnosed 9 months prior to presentation and was treated with a 5-month course of chemotherapy with nanoparticles of gemcitabine and cisplatin as part of a clinical trial. Two months prior to presentation, the patient underwent two sessions of FOLFIRI (folinic acid, fluorouracil, irinotecan) as second-line chemotherapy. There was no history of corrosive intake or alcohol in the past. At admission the patient was hypotensive, with palpable liver margin and ascites. Blood work was modified as shown in [Table 1]. Abdominal ultrasound showed ascites, liver metastasis, and splenomegaly. Esophagogastroduodenoscopy showed AEN, circumferential black discoloration with sharp distal transition to normal mucosa at the gastroesophageal junction, starting from the superior esophageal sphincter ([Fig. 1]), which was more severe in the distal third of the esophagus ([Video 1]), and a bulbar ulcer. Esophageal biopsies were not done, as these are not required for diagnosis [2].

Table 1

Blood work-up upon admission.

Parameter

Result

Total leukocyte count, cells/mm3

22 600

Neutrophils, %

89.3

Thrombocyte count, cells/mm3

117 000

Hemoglobin, g/dL

9.6

Mean corpuscular volume, fL

104

Serum albumin, g/dL

1.8

Creatinine, mg/dL

2.7

Serum urea, mg/dL

85

Total bilirubin, mg/dL

2.4

Conjugated bilirubin, mg/dL

1.8

Alkaline phosphatase, U/L

242

Gamma glutamyl transpeptidase, U/L

848

International normalized ratio

1.32

Prothrombin time, seconds

16.3

Zoom Image
Fig. 1 Proximal esophagus with circumferential lesions and minimal necrotic tissue.

Video 1 Endoscopic aspect of Gurvitis syndrome highlighting the circumferential necrotic lesions, which are more severe in the distal esophagus, and sharp transition to normal mucosa at the gastroesophageal junction.


Quality:

The patient was kept nil-per-os, started on aggressive resuscitation with intravenous fluids, and given proton-pump inhibitor and broad-spectrum antibiotics. His condition did not improve, with acute liver failure and severe coagulopathy (international normalized ratio 6.8), worsened neurological status, hypoglycemia, and finally death by cardiorespiratory arrest after 4 days. Mortality rate is high (30 % – 50 %) and related to severe co-morbidities, as the death rate due to AEN is only 6 % [3] [4].

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Competing interests

None

  • References

  • 1 Zacharia GS, Sangesh K, Tamachandran TM. Acute esophageal necrosis: an uncommon cause of hematemesis. Oman Med J 2014; 29: 302-304
  • 2 Gurvitis E. Black esophagus: acute esophageal necrosis syndrome. World J Gastroenterol 2010; 16: 3219-3225
  • 3 Lin K, Naing Lin A, Lin S. et al. Black esophagus due to metastasis colonic carcinoma. MOJ Clin Med Case Rep 2017; 7: 258-260
  • 4 Ullah W, Mehmood A, Micaily I. et al. Comprehensive review of acute oesophageal necrosis. Br Med J Case Rep 2019; 12: 1-4

Corresponding author

Mihai Ciocîrlan, MD, PhD
Department of Gastroenterology
“Agrippa Ionescu” Hospital
Ion Mincu no 7
PC 011356, Bucharest
Romania   

  • References

  • 1 Zacharia GS, Sangesh K, Tamachandran TM. Acute esophageal necrosis: an uncommon cause of hematemesis. Oman Med J 2014; 29: 302-304
  • 2 Gurvitis E. Black esophagus: acute esophageal necrosis syndrome. World J Gastroenterol 2010; 16: 3219-3225
  • 3 Lin K, Naing Lin A, Lin S. et al. Black esophagus due to metastasis colonic carcinoma. MOJ Clin Med Case Rep 2017; 7: 258-260
  • 4 Ullah W, Mehmood A, Micaily I. et al. Comprehensive review of acute oesophageal necrosis. Br Med J Case Rep 2019; 12: 1-4

Zoom Image
Fig. 1 Proximal esophagus with circumferential lesions and minimal necrotic tissue.