Mallory-Weiss Syndrome

Sporadic condition characterized by esophageal bleeding caused by a mucosal tear in the esophagus as a result of forceful or prolonged vomiting.

First described in 1929 by George Kenneth Mallory and Soma Weiss, American physicians.

Uncommon in children. Responsible for 11 to 13% of significant upper gastrointestinal bleedings in adults.

No genetic component.

Prolonged or forceful vomiting can increase intraesophageal pressure significantly. This may result in lacerations, usually at the gastroesophageal junction. In adults the tears are usually confined to the gastroesophageal junction (49%) but may extend into the esophagus (15%) and stomach (33%). Significant bleeding is unusual and is most likely to occur if the tear extends into the vascular cardia.

Endoscopy of the upper gastrointestinal tracts reveals superficial, longitudinal tears in the esophageal mucosa in the acute phase. Granulation tissue forms later, and the lesion may appear as a white raised streak.

Patients usually present with hematemesis after an episode of acute, severe and prolonged vomiting. Bleeding is usually painless and is rarely significant enough to require blood transfusion. In children, specific treatment is rarely required. If bleeding persists, then treatment modalities include vasopressin, angiographic-guided embolization, and, rarely, surgical control of the bleeding. Pediatric patients usually require anesthesia for endoscopy.

Careful history to determine cause of vomiting and the extent of bleeding. Blood examination: hemoglobin to determine blood loss; blood transfusion if necessary. Consider patient to have full stomach, particularly if bleeding has been extensive.

Correction of anemia and hypovolemia if necessary. Rapid-sequence induction.

May require perioperative antiemetic therapy.