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| http://dx.doi.org/10.1136/bcr-2012-008441 | DOI Listing |
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Acute esophageal necrosis (AEN) is an uncommon endoscopic finding characterized by a patchy or diffuse circumferential black pigmentation of the esophageal mucosa, corresponding to ischemic necrosis. It usually presents with upper gastrointestinal bleeding and is thought to be caused by a systemic low blood flow in patients with predisposing risk factors, like advanced age and cardiovascular comorbidities. After initial hemodynamic stabilization, diagnosis is established by esophagogastroduodenoscopy (EGD) with careful biopsies and histological evaluation.
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Necrotizing fasciitis is a potentially life-threatening infection that can lead to rapid muscular and fascial necrosis, often resulting in sepsis. In addition to the rapid disease progression, diagnosing this disease in children can be challenging as they cannot accurately communicate their symptoms. Spontaneous necrotizing fasciitis secondary to Clostridial infection has rarely been described in the literature but occurs in neutropenic patients with significant morbidity and mortality from myonecrosis and gas gangrene.
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Managing acute coronary syndrome (ACS) in patients with a recent history of gastrointestinal bleeding presents a unique and challenging clinical dilemma, necessitating a careful balance between minimizing ischemic risk and avoiding potentially life-threatening rebleeding. Standard treatment for ACS typically involves dual antiplatelet therapy (DAPT) to prevent recurrent thrombotic events. However, in patients with recent gastrointestinal hemorrhage or significant anemia, these therapies may substantially increase the risk of life-threatening bleeding, complicating the decision-making process and often leading to conservative management strategies.
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