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Black oesophagus, upside-down stomach and cameron lesions: cascade effects of a large hiatal hernia
  1. Smit Sunil Deliwala1,
  2. Murtaza S Hussain1,
  3. Anoosha Ponnapalli1,
  4. Ghassan Bachuwa1 and
  5. Grigoriy E Gurvits2
  1. 1Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
  2. 2Division of Gastroenterology & Hepatology, New York University/Langone Medical Center, New York, New York, USA
  1. Correspondence to Dr Ghassan Bachuwa; gbachuw2{at}


Acute oesophageal necrosis, black oesophagus (BE) or Gurvits syndrome (GS) is a rare form of severe oesophagitis appearing as a striking circumferential discolouration of distal mucosa with various proximal extensions abruptly terminating at the gastro-oesophageal junction. It is most commonly associated with acute exacerbations of medical comorbidities, while associations with altered gut anatomy are rare. We present a unique constellation of BE, Cameron ulcers (CU), and gastric volvulus from a large paraesophageal hiatal hernia. Our patient recently recovered from COVID-19 and was malnourished and frail, while the expanding paraesophageal hiatal hernia turned into an acute organoaxial gastric volvulus with accompanying outlet obstruction. In low-flow post-COVID coagulopathic states, compensatory mechanisms may lack against gastric stunning and sudden massive reflux on the oesophagus. We additionally performed a systematic review and discovered additional cases with coexistent volvulus and paraesophageal hernia, although there are no previous reports of BE with CU, which makes this study the first.

  • gastroenterology
  • oesophagus
  • gastro-oesophageal reflux
  • gastrointestinal surgery

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  • Contributors SD - conception, draft, and acquisitionMurtaza Hussain - Data collection, draft AP - Data collection, draft GB - Draft and review GEG - Interpretation and review

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.