A CASE of UPSIDE-DOWN STOMACH ACCOMPANIED by ACUTE NECROTIZING ESOPHAGITIS

An 83-year-old woman was taken to our hospital by ambulance because of hematemesis. Laboratory examination revealed high blood levels of lactate (35mg/dL), creatinine (2.1mg/dL) and glucose (249mg/dL). Thoracoabdominal CT scans showed a large esophageal hernia, presenting with upside-down stomach and mesenteroaxial volvulus. Urgent endoscopy revealed diffuse black mucosa in the middle and lower esophagus, so-called black esophagus. The abnormal rotation returned to normal by performing the stretching method with a duodenoscope. On the following day, the esophageal lesion was remarkably improved. When encountering a case of upside-down stomach with acute necrotizing esophagitis, endoscopic de-rotation should be immediately considered.