[Treatment of gastric hemorrhage in the Mallory-Weiss syndrome]

The authors have analyzed 25 observations of patients with the Mallory-Weiss syndrome which made up 3,04% of all the patients with gastroduodenal bleedings. The authors emphasize the role of the endoscopic method for examining the patients to diagnose this pathology. The most rational method is believed to be the conservative treatment. When it fails the surgery should be organ-preserving. Twenty four patients were treated conservatively, one patient was subjected to gastrotomy and suturing of the mucosa fissure. All the patients recovered.

[Mallory-Weiss syndrome. Considerations on 27 cases]

Twenty seven patients, inspected by endoscope, and diagnosed as having the Mallory-Weiss syndrome, have been studied taking into account their age, sex, background, clinic presentation, manifestations, number of lacerations, associated lesions and evolution. Twenty three of them were males and 4 females. The age average was 46.7 years. Only 8 patients had intra-abdominal increased pressure, suffering retching and vomiting 7 of them, while one had a cough access. Out of the 21 patients that we controlled, 9 were chronic alcoholism while 3 had ethanol intoxication previously. Immediate prior ingestion of salicylates had taken place in 6 patients. The clinical presentation of 22 of them was gastrointestinal bleeding, that is, 4.9% of all the upper endoscopies carried out within the bleeding patients. Single laceration was present in 22 cases, double one in 4, and triple in 1. We have frequently found endoscopy lesions associated, the most common one (37%), was hiatal hernia. They all were medically treated except one, who was operated because of gastric perforation was associated. Just one of the Mallory-Weiss syndrome patient died, due to an associated diffused bleeding gastritis.

Mallory-Weiss syndrome in a 16-week-old infant

The Mallory-Weiss syndrome is a recognized cause of upper gastrointestinal bleeding in adults. It is a very rare entity in the pediatric age group. The case discussed outlines the reasons for its rarity and the modalities used for its diagnosis.

Mallory-Weiss syndrome. Evolution of diagnostic and therapeutic patterns over two decades

During a 19-year period ending December 1978, we treated 40 patients with upper gastrointestinal bleeding secondary to the Mallory-Weiss syndrome. Thirty patients had the triad of vomiting, hematemesis and alcoholism. The presence of lacerations within the gastric cardia was associated with the presence of hiatal hernia (p = 0.03). Endoscopic examinations demonstrated 32 of 38 additional upper gastrointestinal lesions associated with the syndrome that could have been mistaken as the actual source of hemorrhage. During the second decade, as compared with the first decade, widespread use of fiberoptic esophagogastroscopy led to the identification of the bleeding lacerations in 71% of the patients (versus 47% in the first decade) and in 80% (versus 0% in the first decade) of the patients who required an operation to control the bleeding. Although there was a 7.5% mortality rate in the two decades, the incidence of operative treatment tended to decrease (42-24%; p = 0.13). More impressive were the decreases in transfusions (14 units to 5 units per patient) and in delays before surgery (38 hours to 17 hours) (p equal to 0.05). Improved endoscopic diagnosis facilitates prompt and economic treatment.

Electrocoagulation of actively bleeding Mallory-Weiss tears

Thirty patients with upper gastrointestinal bleeding due to a Mallory-Weiss tear were diagnosed by endoscopy. Seventeen patients had stopped bleeding spontaneously, and 13 were actively bleeding when examined. Ten of these 13 were successfully electrocoagulated with cessation of bleeding without morbidity or mortality. Total cost and length of hospitalization were approximately one-third for those treated by electrocoagulation as compared to surgery. Endoscopic electrocoagulation of actively bleeding Mallory-Weiss tears is often successful and appears to be safe.

Mallory-Weiss syndrome: analysis of fifty-nine cases

Fifty-nine patients with Mallory-Weiss gastroesophageal lacerations are described. These patients consisted of 6% of all cases of upper gastrointestinal tract hemorrhage we evaluated. The most common symptoms were hematemesis (92%) and retching (61%). A history of chronic alcoholism was present in 69.5%, and recent binge drinking in 52.5% of our patients. Diagnosis was made endoscopically (55 patients) or surgically (four patients). Two deaths occurred in the 51 patients who were managed nonoperatively and two deaths occurred in the eight patients who underwent surgery. None of the deaths was related to delay in operative treatment. Eleven patients had late rebleeding, but in only three of these patients was this due to recurrent Mallory-Weiss lesions. We believe the Mallory-Weiss laceration can now be considered to be a relatively benign condition that can be managed successfully by nonoperative means in the majority of cases.

Hematemesis and melena: Mallory-Weiss syndrome

The records of 29 patients with Mallory-Weiss tears diagnosed by endoscopy are reviewed. Ingestion of alcohol was a chief cause of bleeding. Single tears were the largest in number and 68% of the lacerations were seen just distal to the esophago-cardial junction. Lacerations occurred more frequently on the right lateral wall of cardia than on the left lateral wall. Most of these lesions were mild and could be treated medically except for two cases which were surgically treated.

A critical look at the accuracy of endoscopy and double-contrast radiography of the upper gastrointestinal (UGI) tract in patients with substantial UGI hemorrhage

Double-contrast radiography and endoscopy were compared in a prospective study of 100 patients with substantial hemorrhage of the upper gastrointestinal (UGI) tract. Endoscopy enabled detection of the primary bleeding site in 93% of the patients and correct diagnosis of 91% of all UGI lesions present. Double-contrast radiography detected 80% of primary bleeding sites and 76% of all UGI lesions present; whether the double-contrast examination was performed before or after endoscopy did not change its ability to detect lesions. Radiography demonstrated 68% (esophagitis) to 86% (duodenitis) of all superficial lesions. Endoscopy missed lesions in the duodenum and esophagus most frequently, while double-contrast radiography missed lesions in the esophagus most frequently. With the two modalities combined, the overall diagnostic accuracy for all lestions was 99%. Endoscopy and double-contrast radiography are complementary techniques for detecting acute bleeding sites of the UGI tract.

[Radiological aspects of Mallory-Weiss syndrome (author's transl)]

A case of Mallory-Weiss syndrome was diagnosed by joint baryum study and endoscopy. A survey of publications (15 references) shows that this affection is frequent and could be responsable of 5 to 10% of upper digestive hemorrhage of which some are grave. But conventional radiology only exceptionnally reveals these superficial lesions. Without endoscopy and according the ulceration be deep, the radiologist should be able to reveal the lesion a sa niche.

Mallory-Weiss syndrome: retrospective review of eight years' experience

Retrospective review of eight years' experience with the Mallory-Weiss syndrome emphatically supports the need for accurate, early localization of the site of upper gastrointestinal hemorrhage. Pertinent aspects of the history and physical and laboratory evaluation of this group of patients were analyzed to determine the relative merits of each in diagnosis and treatment. Angiography was helpful as a diagnostic aid in a small group of patients. Endoscopy, the cornerstone of diagnosis, is essential in the choice of the management program. Data from this study support the following conclusions: (1) patients not bleeding at the time of endoscopy rarely require surgical intervention; and (2) patients bleeding at the time of endoscopy vary as to their need for operative treatment and deserve a trial of preliminary medical therapy.