An Unusual Cause of Acute Upper Gastrointestinal Bleeding: Acute Esophageal Necrosis

Table 1

	Case 1	Case 2
Age; sex	45 yr; female	66 yr; female
Clinical presentation	Septic shock, acute upper gastrointestinal bleeding	Diabetic ketoacidosis, coffee ground emesis, and epigastric pain
Associated condition	Malnutrition, GERD, chronic liver disease, and alcoholism	Malnutrition, coronary artery disease, hypertension, and diastolic heart failure
Hemoglobin (g/dL)	9.5	8.5
Creatinine (mg/dL)	7.1	1.9
Lactic acid (<2.1 mmol/L)	10	1
Procalcitonin (>0.5 ng/mL is positive)	19.7	1.8
Endoscopic features	Circumferential black esophagus from mid to distal third w/intramural esophageal dissection Duodenal ulcerations with low risk stigmata for bleeding	Isolated circumferential black esophagus from mid to distal third
Etiology	Malnutrition, alcoholism, chronic acid reflux, sepsis, and ischemia	DKA, systemic hypotension, ischemia, and possibly low flow ischemia
Clinical outcome	Deceased	Alive at discharge without short-term complications