Mallory-Weiss Tear

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

  • Epigastric pain

Epidemiology

• • 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

Symptoms and Signs

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

  • Epigastric pain

  • Epigastric tenderness

Laboratory Findings

• • 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)

Imaging Findings

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

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

Rule Out

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

  • Other causes of upper GI hemorrhage

• • Admission to ICU

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

  • NG lavage

  • Upper GI endoscopy

When to Admit

• • All cases of acute GI hemorrhage should be admitted

• • The bleeding can sometimes be controlled by endoscopic therapy

  • Surgical repair by gastrotomy and oversewing the tears

Surgery

Indications

• • Persistent or recurrent bleeding after endoscopic treatment

Medications

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

Treatment Monitoring

• • Serial Hgb to evaluate for ongoing blood loss

Complications

• • Recurrent or ongoing bleeding after endoscopic treatment

Prognosis

• • Postoperative recurrence is rare

References