DOI: https://doi.org/10.36347/sjmcr.2025.v13i04.036

Pages: 724-725

Acute Esophageal Necrosis (AEN), or "black esophagus," is a rare but severe condition primarily affecting elderly patients with multiple comorbidities. It is characterized by diffuse circumferential black discoloration of the esophageal mucosa, usually resulting from ischemia, impaired mucosal defenses, and exposure to gastric contents. We present the case of a 75-year-old female patient with congestive heart failure and atherosclerosis who was diagnosed with AEN during an esophagogastroduodenoscopy performed for epigastric pain. Laboratory findings were within normal limits, and there was no evidence of gastrointestinal bleeding. Conservative management with intravenous proton pump inhibitors (PPIs) and supportive care resulted in significant clinical improvement. This case underscores the importance of recognizing AEN as a differential diagnosis in elderly patients presenting with epigastric pain, even in the absence of upper gastrointestinal bleeding. Early endoscopic diagnosis and appropriate medical management are crucial in improving outcomes.