Alcohol and Sepsis: A Deadly Duo Leading to Acute Esophageal Necrosis

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

American Journal of Gastroenterology

Abstract

Introduction: Acute esophageal necrosis (AEN) is a rare but severe condition most commonly observed in critically ill patients with significant alcohol use and sepsis. This case illustrates the complexity and high risk associated with AEN while demonstrating its severe nature and high mortality. Case Description/Methods: A 43-year-old woman with significant alcohol use presented for altered mental status with hypotension, tachycardia, tachypnea, and acidosis with a pH of 7.02. A CT scan revealed small bowel wall thickening with a coinciding pulmonary consolidation. Septic shock secondary to pneumonia was suspected, and she was managed with norepinephrine, phenylephrine, and vasopressin with vancomycin, meropenem and micafungin and admitted to the ICU. The patient had a significant drop in hemoglobin to 4.3 g/dL and she received 6 units of packed red blood cells and one unit of cryoprecipitate over the next 24 hours. She exhibited one large volume bloody bowel movement prompting the initiation of octreotide and Protonix. Esophagogastroduodenoscopy (EGD) revealed extensive esophageal necrosis with friable eschar formation and ulcerations suggestive of ischemia. A CTA did not indicate gastrointestinal bleeding, perforation, or ischemia but showed progression of pneumonia. Thoracic surgery evaluated the patient with no surgical intervention performed. Treatment for pneumonia continued, and bronchoscopy revealed green frothy secretions. Continuous renal replacement therapy (CRRT) was employed due to acute tubular necrosis. Despite these interventions, the patient’s clinical status and acidosis worsened. Comfort measures were initiated, and the patient expired 13 days following presentation. Discussion: Acute esophageal necrosis is a rare but often fatal condition seen in critically ill patients with risk factors like significant alcohol abuse and sepsis. The pathogenesis involves ischemic insult, acid injury, and impaired mucosal defense. In this case, the patient’s septic shock and severe alcohol abuse, compounded by pneumonia and hypotension with vasopressor support, precipitated the ischemic conditions leading to AEN. Despite aggressive management, including fluid resuscitation, broad-spectrum antibiotics, and CRRT, the patient’s condition deteriorated, highlighting the high mortality rate associated with AEN. This case provides needed context for early recognition and aggressive management in similar clinical contexts, especially in cases with profound, unwavering lactic acidosis (see Figure 1).

Volume

119

Issue

10S

First Page

S2255

Comments

American College of Gastroenterology Annual Scientific Meeting, October 25-30, 2024, Philadelphia, PA

Last Page

S2256

DOI

10.14309/01.ajg.0001042888.19198.2e

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