Introduction: Black esophagus or acute esophageal necrosis is a disease of poorly understood etiology. Our goal is to carry out a literature review on this condition by reporting a case treated in our structure.

Observation: A 69-year-old female patient, hypertensive, who underwent concomitant radiochemotherapy followed by abdominoperineal amputation for lower rectum adenocarcinoma with sphincter involvement, suddenly presented on the 15th postoperative day with moderate abundance hematemesis. Upper gastrointestinal endoscoy revealed extensive necrosis of the middle and lower thirds of the esophagus without gastric or duodenal involvement. There was no caustic ingestion or esophagogastric reflux. The cervical-thoracic-abdominal CT scan showed no transmural necrosis. She was fasted for 7 days and received parenteral nutrition, double dose proton pump inhibitor and blood transfusion. The evolution was favorable with almost total disappearance of the necrosis on upper GI endoscopy control one week later.
 

Conclusion: Black esophagus or acute esophageal necrosis is a rare condition, most often discovered in postoperative context. Proton pump inhibitors and gut rest remain effective means in their management.