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Acute oesophageal necrosis: a rare but potentially fatal association of cocaine use
  1. Waqas Ullah1,
  2. Hafez Mohammad Ammar Abdullah2,
  3. Abdul Rauf3,
  4. Kaiser Saleem4
  1. 1Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, PA, USA
  2. 2Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
  3. 3Department of Internal Medicine, Khyber Medical College, Peshawar, KPK, Pakistan
  4. 4Department of Internal Medicine, Griffin Hospital, Derby, Connecticut, USA
  1. Correspondence to Dr Waqas Ullah, waqasullah.dr{at}


Acute oesophageal necrosis (AON), also known as ‘black oesophagus’, is a rare condition characterised by the necrosis of the oesophagus usually involving the distal part. It has been associated with various conditions, and the pathogenesis is thought to involve hypovolaemia combined with decreased function of oesophageal protective mucosal barriers and may be compounded by the effect of gastric secretions on oesophageal mucosa. The hallmark of this condition is characteristic circumferential black discolouration of the distal oesophagus that may extend proximally. We present a case of a man who presented with haematemesis associated with cocaine abuse. Oesophagogastroduodenoscopy confirmed black oesophagus. The patient was managed with intravenous fluids, packed red blood cell transfusions, proton pump inhibitors and sucralfate suspension; however, he failed to recover. We have also reviewed the previous reported cases of AON in association with cocaine use.

  • gastroenterology
  • endoscopy

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  • Contributors WU and KS did the literature search. HMAA and AR wrote the manuscript.

  • 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.

  • Patient consent Obtained.

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