Cardial balloon tamponade in the treatment of the Mallory-Weiss syndrome

Mallory-Weiss syndrome. Experience in a community hospital

The Mallory-Weiss syndrome is characterized by repeated bouts of retching and/or vomiting followed by the sudden onset of hematemesis or melena. Bleeding arises from linear, nonperforating mucosal lacerations at the cardia, cardioesophageal junction, distal esophagus, or a combination of these sites. Hiatal hernia is often a coexisting finding. Severity of hemorrhage can vary from mild to severe (100 to 2,000 ml). The clinical course is usually benign. The diagnosis can be suspected from the history and confirmed by upper gastrointestinal endoscopy. In the majority of patients, medical management controls the bleeding. About 10% to 20% of unselected patients require surgical intervention. With the proper, prompt use of fiberoptic endoscopy in the diagnosis of upper gastrointestinal hemorrhage has come an increase in the number of cases of Mallory-Weiss syndrome being identified. This is true even in community hospitals. The result has been a decrease in surgical intervention and overall mortality.

Mallory-Weiss syndrome secondary to cis-platinum chemotherapy: an unusual complication

The Mallory-Weiss syndrome is a relatively infrequent cause of digestive tract bleeding and most cases have been described in alcoholics. Nonoperative management is frequently successful. We present here a case of sudden onset of wretching and vomiting after IV infusion of cis-platinum for recurrent carcinoma of the uterine cervix in which the patient had profuse hematemesis secondary to three posterior gastroesophageal tears requiring operative intervention after failure of nonsurgical management. This is an unusual complication of antineoplastic chemotherapy and its prevention is emphasize in this paper.

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.

The Mallory-Weiss syndrome

A policy of immediate investigation of patients with haematemesis or melaena or both led to the diagnosis of the Mallory-Weiss syndrome in 16 out of 121 patients admitted to a combined medical-surgical unit over three and a half years. A typical history suggestive of the diagnosis was obtainable in only nine of the 16 patients, though recent alcohol intake was high in another four. All patients survived the episode. Establishment of the diagnosis by oesophagogastroscopy was of special benefit when surgery was needed for control of continuing blood loss, but it also simplified the subsequent medical management of those patients in whom bleeding stopped spontaneously. The incidence of 13.2% in this series suggests that the Mallory-Weiss syndrome may be a relatively common cause of upper gastrointestinal bleeding.