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‘Black esophagus’or acute esophageal necrosis is a rare condition, frequently affecting the distal esophagus with a sharp transition to normal-appearing mucosa at the gastroesophageal junction. It is characterized by circumferential blackish discoloration and necrosisof the mucosa due to severe hemodynamic compromise.The pathogenesis of black esophagus is unclear, but a “two-hit” hypothesis for a dominant mucosal necrosis has been described - a low-flow vascular setting followed by an altered reparative ability of the mucosal barrier systems. The etiology is usually multifactorial, triggered by an acute event. It is associated with a high mortality rate of 31.8%−50%, most of the deaths caused by underlying illnesses. Mortality specific to acute esophageal necrosis is approximately 6%.We report a case of 72-year-old hypertensive male patient presenting with perforated gastric ulcers and sepsis. Distal gastrectomy revealed two candidial perforations. Patient expired on second post- operative day. Autopsy revealed a diffuse circumferential blackish discoloration of distal one third of the esophageal mucosa abruptly stopping at the gastro esophageal junction. On microscopy, the esophageal mucosa was ulcerated, and covered by necro-inflammatory exudate and blackish pigment extending upto the muscularis propria. Many submucosal vessels showed fresh fibrin thrombi. Special stains for fungus were negative. The diagnosis of black esophagus or acute esophageal necrosis was made. Other findings included fungal peritonitis, ischemic heart disease and chronic pyelonephritis with right-sided nephrolithiasis. The cause of death was related to septicaemia.

Atypical Leiomyoma with Amianthoid-like Fibers (ALWAF) is a very rare entity with a couple of cases in the literature. Amianthoid fibers are thick acellular mats composed of crystalline collagen fibers. This is an unusual case of a 53-year-old female with Chronic Kidney Disease (CKD), who presented with pain in the abdomen for three weeks. Computed Tomography (CT) showed a degenerated subserosal leiomyoma in the posterior wall of the uterus which had ruptured leading to haemoperitoneum. An emergency exploratory laparotomy with simple hysterectomy was done. Histopathology revealed a ruptured atypical leiomyoma with abundant amianthoid-like fibers. The patient expired seven days after surgery due to hypovolaemic shock. Rupture of the uterus in leiomyoma with amianthoid fibers has not been reported in the literature. Awareness of this entity is important in view of acute catastrophic consequences like haemoperitoneum, hypovolaemic shock, and death.

Abstract Background Dieulafoy lesion, also known as calibre persistent artery is a rare cause of massive GI bleeding. It’s an abnormal sub-mucosal artery protruding from a minute mucosal defect (≤3 mm). Commonest location is in proximal stomach while occurrence in small intestine, especially ileum is extremely rare. Case presentation A 26 year old female presented with lower gastrointestinal bleeding. Preliminary investigations failed to locate the exact source of bleed. At laparotomy, an ulcerated nodular lesion, approximately 0.8 cm in diameter was identified in distal ileum. Histology revealed it to be Dieulafoy lesion. Conclusion Although uncommon, ileal dieulafoy is one of the causes of obscure gastrointestinal bleeding that could result in treacherous and life-threatening gastrointestinal haemorrhage. Hence, it should be considered in the differential diagnosis of active GI bleeding. The definitive diagnosis is based only on histopathology.