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.
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
Gryboski J: Traumatic injury of the esophagus, in Walker W, Durie P,
Hamilton J, Walker-Smith J, Watkins J (eds): Pediatric Gastrointestinal Disease. 2nd ed. Mosby, St. Louis,
1996, p 444.
Michel L, Serrano A, Malt R: Mallory-Weiss syndrome: Evolution of diagnostic
and therapeutic patterns over two decades. Ann Surg