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Mallory Weiss tear

Dr Yuranga Weerakkody and Dr Isha Gujrathi et al.

A Mallory Weiss tear occurs due to violent projection of gastric contents against the lower esophagus which results in mucosal + submucosal tear with involvement of the venous plexus. 

Clinical presentation

Patients present with massive painless haematemesis.

Pathology

Tears most commonly involve the distal esophagus at the gastro-esophageal junction. It is more common in alcoholics with repeated episodes of vomiting.

Radiographic features

Fluoroscopy

On a Barium swallow study, there may be an incomplete leak of Barium.

CT

A mucosal laceration without transmural perforation is likely to be occult on CT. However, CT images of the esophagus many occasionally show evidence of haemorrhage or foci of extraluminal gas at a site of mucosal injury 2.

Treatment and prognosis

Unless there is persisting bleeding, the treatment like that of other mucosal lacerations, is supportive 2. Most patients with upper gastrointestinal hemorrhage from a Mallory-Weiss tear cease bleeding spontaneously and do not require specific therapy 3.

Differential diagnosis

  • Boerhaave syndrome : in which there is no haematemesis as there is complete transmural disruption of the oesophageal wall with blood escaping into the mediastinum

Etymology

It is named after G. Kenneth Mallory, American (US) Pathologist (1900 -1986) and Soma Weiss,  American (US) Physician (1898 - 1942)1

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