Acute Esophageal Necrosis (Gurvits Syndrome): A Rare Cause of Upper Gastrointestinal Bleeding in Somalia.

Abstract

Acute esophageal necrosis, also known as Gurvits syndrome, is a rare condition due to ischemic compromise and thromboembolic injury to esophagus associated with high mortality. Endoscopically, it is characterized by the circumferential black discoloration of the esophagus. We present the case of a 55-year-old male with a history of multiple comorbidities, including uncontrolled type 2 diabetes mellitus, hypertension, smoker, peripheral arterial disease, and a right above-ankle amputation, who presented with active hematemesis and melena with hemodynamic instability. An esophagogastroduodenoscopy revealed diffuse, circumferential necrotizing esophagitis with black discoloration and ulcerations affecting the middle and distal thirds of the esophagus. The severity increased from the proximal to the distal esophagus, abruptly ending at the gastroesophageal junction. These endoscopic findings, combined with the patient's medical history, were consistent with a diagnosis of acute esophageal necrosis. The patient was admitted to the ward and managed conservatively with intravenous fluid resuscitation, IV proton pump inhibitor twice daily, sucralfate 1 gram every six hours, strict glycemic control using insulin, total parenteral nutrition, empirical IV antibiotics, and placed on nil-per-oral (NPO) for three days. A follow-up esophagogastroduodenoscopy conducted twenty-two days post-admission showed complete healing of the esophageal mucosa without stricture formation. Despite its rarity, prompt diagnosis and management of acute esophageal necrosis are crucial due to its association with high morbidity and mortality, as well as the need to minimize complications such as perforations and strictures, particularly in patients with comorbidities. This case report aims to raise awareness among clinicians in Somalia of this condition as a differential diagnosis in upper gastrointestinal bleeding and to highlight the importance of timely intervention to prevent adverse outcomes.