Mallory-Weiss tear - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Mallory-Weiss Tear (MWT) accounts for 3% to 15% of people with upper gastrointestinal (GI) bleed.
Commonly presents with hematemesis after an episode of forceful or recurrent retching, vomiting, coughing, or straining.
Definitive diagnosis is usually made by esophagogastroduodenoscopy.
MWT is mostly self limiting, so treatment is generally supportive. Emergency treatment is reserved for those showing signs or symptoms of instability.
First-line treatment in an actively bleeding patient is therapeutic endoscopy. Endoscopy can also help to rule out other causes of upper GI bleeding.

Actively bleeding tear appears as a red longitudinal defect with normal surrounding mucosa

From the collection of Juan Carlos Munoz, MD, University of Florida

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Definition

Epidemiology

Etiology

Pathophysiology

Images

56-year-old female had an EGD for upper GI bleeding 5 days prior treated with a single clip. She continued having melena and low Hb for the following 5 days after initial procedure. A second EGD detected a longitudinal gastric laceration without perforation on the corpus to cardia.
Actively bleeding tear appears as a red longitudinal defect with normal surrounding mucosa
Epinephrine 1:10,000 is injected intravenously next to Mallory-Weiss tear
Mallory-Weiss tear after epinephrine injection (the bleeding has stopped, allowing better visualization of the lesion)
A hemoclip deployed in the center of the lesion (no previous epinephrine was infused in this case)
Nonbleeding adherent clot
Three hemoclips deployed to complete closure of the mucosal defect
Diagnosed as a gastric tear without perforation from previous EGD evaluation. Managed with application of hemoclips and emergency surgical consult.
A total of seven hemoclips were applied.
Sixteen days later, the tear has closed.

Citations

Key Articles

Graham DY, Schwartz JT. The spectrum of the Mallory-Weiss tear. Medicine (Baltimore). 1978;57:307-318.[Abstract]
Sugawa C, Benishek D, Walt AJ. Mallory-Weiss syndrome: a study of 224 patients. Am J Surg. 1983;145:30-33.[Abstract]
Michel L, Serrano A, Malt RA. Mallory-Weiss syndrome: evolution of diagnostic and therapeutic patterns over two decades. Ann Surg. 1980;192:716-721.[Abstract][Full Text]
Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med. 2019 Dec 3;171(11):805-22.[Abstract][Full Text]
Hwang JH, Fisher DA, Ben-Menachem T, et al. The role of endoscopy in the management of acute non-variceal upper GI bleeding. Gastrointest Endosc. 2012 Jun;75(6):1132-8.[Abstract][Full Text]

Referenced Articles

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