背景:急性食管坏死(AEN),通常称为Gurvits综合征或“黑食道”,是一种罕见的临床疾病。我们介绍了一例AEN与糖尿病酮症酸中毒(DKA)相关的病例。
方法:一名66岁男性因咖啡磨呕吐来到我院,呼吸困难,和全身不适。他使用胰岛素治疗2型糖尿病,并且没有服用药物,包括胰岛素,好几天了.实验室分析显示严重的高血糖(730mg/dL),正常细胞性贫血(血红蛋白水平,7.7g/dL;平均红细胞体积,100.4fL),高血钾(7.6mEq/L),和高水平的血尿素(98.7mg/dL)。在尿液中检测到酮和葡萄糖,血清β-羟基丁酸升高(2132µmol/L)。动脉血气分析证实代谢性酸中毒(pH,7.29;HCO3,10.5mmol/L)。总的来说,患者被诊断为DKA和上消化道出血。患者的病情通过静脉输液得到改善,他接受静脉注射胰岛素治疗DKA.根据这些发现,患者被诊断为DKA和上消化道出血。患者接受了食管胃十二指肠镜检查(EGD),发现食管中段和远端环状坏死,紧邻胃食管交界处。然后用静脉内质子泵抑制剂治疗患者。患者通过保守治疗继续好转,随后病情稳定出院。出院后14天重复的EGD显示坏死样粘膜改变完全愈合,而食管没有狭窄形成。
结论:AEN是罕见的,但可能危及生命的上消化道出血病例。因此,临床医生应意识到AEN是糖尿病控制不佳和显著合并症的老年患者上消化道出血的潜在原因.
BACKGROUND: Acute esophageal necrosis (AEN), commonly referred to as Gurvits syndrome or \"black esophagus\", is a rare clinical disease. We present a case of AEN associated with diabetic ketoacidosis (DKA).
METHODS: A 66-year-old male came to our hospital with coffee-ground emesis, dyspnea, and general malaise. He was treated for type 2 diabetes mellitus using insulin and had not been taking his medication, including insulin, for several days. Laboratory analysis revealed severe hyperglycemia (730 mg/dL), normocytic anemia (hemoglobin level, 7.7 g/dL; mean corpuscular volume, 100.4 fL), high serum potassium (7.6 mEq/L), and a high level of blood urea (98.7 mg/dL). Ketones and glucose were detected in the urine, and serum β-hydroxybutyrate was elevated (2132 µmol/L). Arterial blood gas analysis confirmed metabolic acidosis (pH, 7.29; HCO3, 10.5 mmol/L). Collectively, the patient was diagnosed with DKA and upper gastrointestinal bleeding. The patient\'s condition improved with intravenous fluids, and he received intravenous insulin to treat DKA. According to these findings, the patient was diagnosed with DKA and upper gastrointestinal bleeding. The patient underwent esophagogastroduodenoscopy (EGD) which revealed a circumferential necrosis of the middle and distal esophagus, immediately proximal to the gastroesophageal junction. The patient was then treated with an intravenous proton pump inhibitor. The patient continued to improve with conservative treatment and was subsequently discharged in a stable condition. An EGD repeated 14 days after discharge showed complete healing of the necrotic-like mucosal change without stricture formation of the esophagus.
CONCLUSIONS: AEN is rare but potentially life-threatening case of upper gastrointestinal bleeding. Therefore, a clinician should be aware of AEN as a potential cause of upper gastrointestinal bleeding in elderly patients with poorly controlled diabetes and significant comorbidities.