Supplementary Material for: An Unusual Complication of Diverticular Bleed: Dysphagia and Food Impaction from Black Esophagus

Acute esophageal necrosis, or black esophagus, is a rare clinical phenomenon typically seen in older men after an acute triggering event. It may present with dysphagia due to stricturing or dysmotility, a complication of severe esophageal inflammation. Here we describe a case of a woman with several cardiovascular risk factors who developed black esophagus following diverticular-related hemorrhagic shock and presented with chest pain followed by dysphagia and food impaction likely as a result of mucosal sloughing and altered esophageal motility. The diagnosis was confirmed endoscopically and pathology revealed coagulative necrosis due to ischemia. Acute esophageal necrosis should be suspected in patients with cardiovascular risk factors and hemodynamic compromise, and may be confirmed with endoscopy. As dysphagia may complicate this condition, slow advancement of diet while healing is advised.