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Essential Features

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  • • Hematemesis or coffee ground emesis following forceful vomiting or retching

    • Epigastric pain

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Epidemiology

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  • • Responsible for about 10% of cases of acute upper GI hemorrhage

    • Lesion consists of a 1- to 4-cm longitudinal tear in the gastric mucosa near the esophagogastric junction, extending through the mucosa and submucosa but not usually into the muscularis mucosae

    • About 75% of these lesions are confined to the stomach; 20% straddle the esophagogastric junction; and 5% are entirely within the distal esophagus

    • 67% of patients have a hiatal hernia

    • In about 90% of patients, the bleeding stops spontaneously

    • The majority of patients are alcoholics

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Clinical Findings

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Symptoms and Signs

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  • • The patient first vomits food and gastric contents, followed by forceful retching and then bloody vomitus

    • Epigastric pain

    • Epigastric tenderness

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Laboratory Findings

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  • • HGB may be unchanged because of acute blood loss

    • Obtain CBC, type and cross, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR)

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Imaging Findings

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  • Upper GI endoscopy: Evidence of gastric and/or distal esophageal mucosal tear with bleeding

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Diagnostic Considerations

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  • • As in any case of acute upper GI bleeding, endoscopy should be performed emergently for diagnosis and possible treatment

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Rule Out

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  • • Boerhaave syndrome: rupture of the distal esophagus produced by vomiting

    • Other causes of upper GI hemorrhage

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Work-up

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  • • Admission to ICU

    • Laboratory tests (type and cross, CBC, PT, PTT, INR)

    • NG lavage

    • Upper GI endoscopy

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When to Admit

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  • • All cases of acute GI hemorrhage should be admitted

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Treatment and Management

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  • • The bleeding can sometimes be controlled by endoscopic therapy

    • Surgical repair by gastrotomy and oversewing the tears

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Surgery

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Indications
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  • • Persistent or recurrent bleeding after endoscopic treatment

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Medications

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  • • H2 blockers, proton pump inhibitors to possibly decrease risk of rebleeding

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Treatment Monitoring

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  • • Serial Hgb to evaluate for ongoing blood loss

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Complications

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  • • Recurrent or ongoing bleeding after endoscopic treatment

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Prognosis

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  • • Postoperative recurrence is rare

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Resources

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References

Kortas DY. Mallory-Weiss tear: predisposing factors and predictors of a complicated course. Am J Gastroenterol. 2001;96:2863.  [PubMed: 11693318]

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Essential Features

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  • • Varying degrees of failure or absence of rotation with the small intestine being on the right and colon on the left with narrow superior mesenteric artery pedicle and Ladd ...

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