Mallory-Weiss Syndrome

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DEFINITION

Oesophageal mucosal disruption, usually a consequence of vomiting.

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EPIDEMIOLOGY

5-15% of UGI bleeds

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AETIOLOGY

Excessive vomiting usually
Also by violent force, e.g. seizure, coughing.

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BIOLOGICAL BEHAVIOUR

Pathophysiology
Pylorus closes while stomach and abdo wall contract violently
Large pressure gradient between proximal stomach and distal esophagus.
Elevation of GEJ into low-pressure thoracic cavity causes a rapid pressure inside distal oesophagus
--> rapidly stretches and tears mucosa.


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MANIFESTATIONS

Symptoms
Vomiting
Haemetemesis
- can be brisk
- bright red blood in stool

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INVESTIGATIONS

See below
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MANAGEMENT

1. Assess Severity and Achieve Stability
Large bore access,
Blood samples for FBC, Coags, X-match
Serial assessments

2. UGI Scope
Frequent lavage for adequate view
All potential sources need to be considered, careful inspection of all regions.
Most tears are just below GEJ on lesser curve
- mostly involve a single tear but multiple tears are possible.
Up to 1/3 will have concurrent pathologies

3. Treat?
Self-limiting in most cases - 80-90%
- so not really much interest to surgeons.
Heals in 2-3d anyway.
If no active bleeding:
--> PPI, observation
If active bleeding:
Injection, coagulation, haemoclips = especially good.
Sometimes in combination.
Banding if concurrent varices.

4. Surgery
Surgery reserved for patients who fail to stop bleeding with endoscopy.
Very rare
Gastrotomy longitudinally, closed in two-layers with a running absorbable.
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REFERENCES

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