Mallory-Weiss tear

Last revised by Dr Saneej Kanhirat on 17 Aug 2021

Mallory-Weiss tears occur due to violent projection of gastric contents against the lower esophagus, which results in mucosal and submucosal tear with involvement of the venous plexus. The resultant clinical syndrome is known as Mallory-Weiss syndrome

Patients present with painless hematemesis.

It is more common in alcoholics or after episodes of binge drinking, after repeated episodes of retching or vomiting.

They can also happen as a result of an endoscopy2.

A Mallory-Weiss tear is a laceration that runs longitudinally in the distal esophagus or through the gastroesophageal junction.

Radiographically, a mucosal laceration without transmural perforation is likely to be undetectable2.

On a Barium swallow study, there may be undetectable2

On double-contrast barium swallow, these mucosal lacerations can be seen as thin, longitudinal collections of barium just above the gastroesophageal junction or distal esophagus5.

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

Unless there is persistent 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.

It was first described in 1929 by George Kenneth Mallory (1900-1986), American pathologist, and Soma Weiss (1898-1942), American physician 1.

  • Boerhaave syndrome: no hematemesis as there is complete transmural disruption of the esophageal wall with blood escaping into the mediastinum

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