近期化疗背景下的急性食管坏死和十二指肠疾病。

HCA healthcare journal of medicine Pub Date : 2023-08-29 eCollection Date: 2023-01-01 DOI:10.36518/2689-0216.1517
Kulveer Dabb, Ryan Jansen van Rensburg, Heba Yusuf, Daniel Klein, Alexander D Lake, Mohamed Kaif
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引用次数: 0

摘要

引言:急性食管坏死(AEN),通常被称为“黑色食管”或Gurvits综合征,是一种罕见的以食管远端弥漫性黑色粘膜为特征的疾病。大多数情况下,患者是一名患有多种合并症的老年男性,表现为上消化道出血。确切的发病机制尚不清楚,但它通常被认为是继发于患有某些继发性合并症的危重患者的急性血管低灌注或食管粘膜缺血,如肾功能不全、糖尿病、血脂异常、冠状动脉疾病、营养不良、酗酒或与潜在恶性肿瘤有关。病例介绍:我们报告了一例78岁女性的AEN病例,该患者最近两周前开始了卡铂和紫杉醇化疗方案。患者接受了EGD检查,发现整个食道都有AEN,十二指肠第二部分出现坏死和焦痂。患者在接受输血、服用nil-per-os并开始质子泵抑制剂(PPI)治疗后最初有所改善,但鉴于其透明细胞子宫癌症和其他合并症的严重性,她最终死亡。结论:虽然开始化疗导致AEN的情况很少见,但应将其视为一种潜在的病因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute Esophageal Necrosis and Duodenal Disease in the Setting of Recently Initiated Chemotherapy.

Introduction: Acute esophageal necrosis (AEN), commonly referred to as "black esophagus" or Gurvits syndrome, is a rare condition characterized by diffuse black mucosa in the distal esophagus. Most often, the patient is an older male with multiple comorbidities, presenting with upper gastrointestinal bleeding. The exact pathogenesis is unclear, but it is often thought to be secondary to acute vascular hypo-perfusion or ischemia of the esophageal mucosa in critically ill patients with certain secondary comorbid conditions such as renal insufficiency, diabetes mellitus, dyslipidemia, coronary artery disease, malnourishment, alcohol abuse, or association with an underlying malignancy.

Case presentation: We present a case of AEN in a 78-year-old female following the recent start of a chemotherapy regimen with carboplatin and paclitaxel two weeks prior. The patient underwent EGD and was found to have AEN throughout the entirety of her esophagus with necrosis and eschars seen up to the second part of the duodenum. The patient initially improved after receiving blood transfusions, being made nil-per-os, and starting proton pump inhibitor (PPI) therapy, but she ultimately died given the severity of her clear cell uterine cancer and other comorbidities.

Conclusion: Although it is rare that initiation of chemotherapy leads to AEN, it should be considered as a potential etiology.

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