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Esophageal Laceration (Mallory-Weiss Syndrome)

By Kristle Lee Lynch, MD, Assistant Professor of Medicine, Perelman School of Medicine at The University of Pennsylvania

An esophageal laceration (Mallory-Weiss syndrome) is a tear that does not penetrate the wall of the esophagus.

  • The tear can be caused by forceful vomiting.

  • Symptoms include blood in vomit.

  • The diagnosis is based on upper endoscopy and laboratory tests.

  • When needed, treatment includes measures to stop the bleeding and rarely surgery.

The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach.

A laceration of the lower esophagus and the upper part of the stomach during forceful vomiting, retching, or hiccups is called a Mallory-Weiss tear. The tear may rupture blood vessels, which then bleed. Mallory-Weiss syndrome was initially described in alcoholics, but it can occur in anyone who vomits forcefully.

Mallory-Weiss syndrome is the cause of about 5% of bleeding episodes in the upper digestive tract (see also Gastrointestinal Bleeding).

Did You Know...

  • Forceful vomiting can tear the esophagus.

Symptoms

The first symptom is usually the appearance of bright-red blood in vomit. Vomiting blood is called hematemesis. Some people feel sharp pain in the lower chest when the esophagus tears during vomiting.

Diagnosis

  • Upper endoscopy

Doctors suspect the diagnosis of Mallory-Weiss syndrome in people who have blood in their vomit after one or more episodes of vomiting. If the amount of bleeding is small, doctors may wait to do testing because the bleeding may stop on its own.

If the bleeding is severe or does not stop on its own, doctors do upper endoscopy. During upper endoscopy, doctors examine the esophagus using a flexible tube called an endoscope. Upper endoscopy allows doctors to see the bleeding source and often treat it at the same time.

If bleeding is rapid or severe, doctors sometimes do angiography. During angiography, doctors use a catheter to inject an artery with a dye that can be seen on x-rays.

Treatment

  • Measures to stop the bleeding

  • Sometimes surgery

Most bleeding episodes stop by themselves, but sometimes the doctor must do endoscopy and take measures to stop the bleeding. Measures include using heat to cauterize the bleeding blood vessel, clipping it closed, or injecting a drug into it.

Alternatively, the doctor may inject vasopressin or epinephrine into the bleeding blood vessel during angiography to stop the bleeding.

People who lose a lot of blood require a blood transfusion.

Surgery is rarely required.

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