Mallory-Weiss tears occur due to violent projection of gastric contents against the lower oesophagus, 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 haematemesis.
Tears most commonly involve the distal oesophagus at the gastro-oesophageal junction. It is more common in alcoholics or after episodes of binge drinking, after repeated episodes of retching or vomiting.
On a contrast swallow study, there may be a leak of contrast.
A mucosal laceration without transmural perforation is likely to be occult on CT. However, CT images of the oesophagus many occasionally show evidence of haemorrhage or foci of extraluminal gas at a site of mucosal injury 2.
Treatment and prognosis
Unless there is persistent bleeding, the treatment like that of other mucosal lacerations, is supportive 2. Most patients with upper gastrointestinal haemorrhage from a Mallory-Weiss tear cease bleeding spontaneously and do not require specific therapy 3.
History and etymology
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 haematemesis as there is complete transmural disruption of the oesophageal wall with blood escaping into the mediastinum
- 1. Kanne JP, Rohrmann CA, Lichtenstein JE. Eponyms in radiology of the digestive tract: historical perspectives and imaging appearances. Part I. Pharynx, esophagus, stomach, and intestine. Radiographics. 26 (1): 129-42. doi:10.1148/rg.261055084 - Pubmed citation
- 2. Young CA, Menias CO, Bhalla S et-al. CT features of esophageal emergencies. Radiographics. 2008;28 (6): 1541-53. doi:10.1148/rg.286085520 - Pubmed citation
- 3. Fisher RG, Schwartz JT, Graham DY. Angiotherapy with Mallory-Weiss tear. AJR Am J Roentgenol. 1980;134 (4): 679-84. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Butler ML. Radiologic diagnosis of Mallory-Weiss syndrome. Br J Radiol. 1973;46 (547): 553-4. doi:10.1259/0007-1285-46-547-553 - Pubmed citation
- oesophageal dysmotility
- oesophageal tumours
- benign oesophageal neoplasms
- malignant oesophageal neoplasms
- gastro-oesophageal reflux disease
- oesophageal stricture