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Perogio M, Simonit F, Da Broi U, Desinan L. Manner of death determination in a case of gastric mucosal tears. Leg Med (Tokyo) 2024; 66:102367. [PMID: 38039656 DOI: 10.1016/j.legalmed.2023.102367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Gastric tears are rarely described in the forensic pathological literature, although they can lead to a fatal acute exsanguination. Such lesions can arise from several conditions leading to an increased intragastric pressure, such as Mallory Weiss syndrome, cardiopulmonary resuscitation, acute barotrauma and operative procedures, showing peculiar morphological features. We present a case of a 32-year-old drug addicted white woman found dead in a pool of blood in the house of her drug dealer, after taking a dose of intravenous heroin. At autopsy, abundant bloody gastric content and multiple and long gastric tears, extending from the cardias and fundus regions to the gastric corpus were observed; one of them involved the subserous region, resulting in a gastric wall rupture. The victim had no history of recent vomiting and of gastro-intestinal pathologies. Drugs and ethanol levels detected in the specimens of the victim were not consistent with lethal concentrations, thus the death was attributed to acute exsanguination. After reviewing the literature, it turned out that morphological aspects of the gastric tears, such as number, size and topographical distribution, observed at autopsy were atypical compared to those of typical gastric lacerations.
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Affiliation(s)
- Maurizio Perogio
- Department of Medical, Surgical and Health Sciences, School of Legal Medicine, University of Trieste, Trieste, Italy.
| | - Francesco Simonit
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
| | - Ugo Da Broi
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
| | - Lorenzo Desinan
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
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Lieto E, Auricchio A, Belfiore MP, Del Sorbo G, De Sena G, Napolitano V, Ruggiero A, Galizia G, Cardella F. Mallory-Weiss syndrome from giant gastric trichobezoar: A case report. World J Gastrointest Surg 2023; 15:972-977. [PMID: 37342849 PMCID: PMC10277944 DOI: 10.4240/wjgs.v15.i5.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/02/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Mallory-Weiss syndrome (MWS), representing a linear mucosal laceration at the gastroesophageal junction, is a quite frequent cause of upper gastrointestinal bleeding, usually induced by habitual vomiting. The subsequent cardiac ulceration in this condition is likely due to the concomitance of increased intragastric pressure and inappropriate closure of the gastroesophageal sphincter, collectively inducing ischemic mucosal damage. Usually, MWS is associated with all vomiting conditions, but it has also been described as a complication of prolonged endoscopic procedures or ingested foreign bodies.
CASE SUMMARY We described herein a case of upper gastrointestinal bleeding in a 16-year-old girl with MWS and chronic psychiatric distress, the latter of which deteriorated following her parents’ divorce. The patient, who was residing on a small island during the coronavirus disease 2019 pandemic lockdown period, presented with a 2-mo history of habitual vomiting, hematemesis, and a slight depressive mood. Ultimately, a huge intragastric obstructive trichobezoar was detected and discovered to be due to a hidden habit of continuously eating her own hair; this habit had persisted for the past 5 years until a drastic reduction in food intake and corresponding weight loss occurred. The relative isolation in her living status without school attendance had worsened her compulsory habit. The hair agglomeration had reached such enormous dimensions and its firmness was so hard that its potential for endoscopic treatment was judged to be impossible. The patient underwent surgical intervention instead, which culminated in complete removal of the mass.
CONCLUSION According to our knowledge, this is the first-ever described case of MWS due to an excessively large trichobezoar.
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Affiliation(s)
- Eva Lieto
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
| | - Annamaria Auricchio
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
| | - Maria Paola Belfiore
- Department of Precision Medicine, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
| | - Giovanni Del Sorbo
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
| | - Gabriele De Sena
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
| | - Vincenzo Napolitano
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
| | - Alessio Ruggiero
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
| | - Gennaro Galizia
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
| | - Francesca Cardella
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Napoli 80138, Campania, Italy
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Yamasaki T, Sakata Y, Suekane T, Nebiki H. Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia. Clin Endosc 2020; 54:916-919. [PMID: 33176411 PMCID: PMC8652158 DOI: 10.5946/ce.2020.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 11/14/2022] Open
Abstract
Mallory-Weiss tears (MWT) are occasionally encountered during endoscopic procedures. Esophageal endoscopic submucosal dissection (ESD) is widely performed under general anesthesia to avoid unexpected body movements. We present the case of a 68-year-old woman with squamous cell carcinoma. Although ESD was performed under general anesthesia, a gastric perforation at the MWT caused by gastric inflation was observed after the procedure. The perforation was closed endoscopically, and she was discharged without any sequelae. Although general anesthesia is useful for esophageal ESD, it should be noted that it can cause MWT, and in rare cases, gastric perforation, due to gastric inflation during the procedure.
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Affiliation(s)
- Tomoaki Yamasaki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Yuhei Sakata
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Takehisa Suekane
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
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Chen W, Zhu XN, Wang J, Zhu LL, Gan T, Yang JL. Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms. World J Gastroenterol 2019; 25:5174-5184. [PMID: 31558865 PMCID: PMC6747285 DOI: 10.3748/wjg.v25.i34.5174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/15/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adverse events during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, the Mallory-Weiss Tear (MWT) during esophageal ESD remains under investigation. AIM To investigate the incidence and risk factors of the MWT during esophageal ESD. METHODS From June 2014 to July 2017, patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed. The clinicopathological characteristics of the patients were collected. Patients were divided into an MWT group and non-MWT group based on whether MWT occurred during ESD. The incidence of MWTs was determined, and the risk factors for MWT were then further explored. RESULTS A total of 337 patients with 373 lesions treated by ESD were analyzed. Twenty patients developed MWTs during ESD (5.4%). Multivariate analysis identified that female sex (OR = 5.36, 95%CI: 1.47-19.50, P = 0.011) and procedure time longer than 88.5 min (OR = 3.953, 95%CI: 1.497-10.417, P = 0.005) were independent risk factors for an MWT during ESD. The cutoff value of the procedure time for an MWT was 88.5 min (sensitivity, 65.0%; specificity, 70.8%). Seven of the MWT patients received endoscopic hemostasis. All patients recovered satisfactorily without surgery for the laceration. CONCLUSION The incidence of MWTs during esophageal ESD was much higher than expected. Although most cases have a benign course, fatal conditions may occur. We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region.
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Affiliation(s)
- Wei Chen
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Nan Zhu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jin Wang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lin-Lin Zhu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tao Gan
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jin-Lin Yang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Cuccì M, Caputo F, Fraternali Orcioni G, Roncallo A, Ventura F. Transition of a Mallory-Weiss syndrome to a Boerhaave syndrome confirmed by anamnestic, necroscopic, and autopsy data: A case report. Medicine (Baltimore) 2018; 97:e13191. [PMID: 30544378 PMCID: PMC6310542 DOI: 10.1097/md.0000000000013191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/17/2018] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Spontaneous esophageal rupture (Boerhaave syndrome) is a rare, though frequently fatal, event. It is generally caused by a sudden increase in pressure inside the esophagus. In some cases, full-thickness perforations of the esophagus may develop from previous lesions that initially involve only the esophageal mucosa (Mallory-Weiss syndrome) and which, following further triggering events, give rise to a transmural lesion. PATIENT CONCERNS Here, we present the case of a 45-year-old subject who suddenly died of acute cardio-respiratory failure, an autopsy was performed to identify the cause of death. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES The autopsy examination revealed a full-thickness rupture of the esophageal wall. Through the integration of necroscopy findings, anamnestic data, and histopathological examination, it has been possible to establish that complete esophageal rupture resulted from the evolution of a previous partial lesion of the esophageal wall, and that an untreated Mallory-Weiss syndrome evolved into a rapidly fatal Boerhaave syndrome. LESSONS This case shows that distal esophageal tears, rather than constituting a distinct entity, may be part of a spectrum of diseases and that a partial lesion of the esophageal wall caused by barogenic injury may evolve into a full-thickness rupture following further barotraumas.
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Affiliation(s)
- Maria Cuccì
- Department of Legal and Forensic Medicine, University of Genova, Genova
| | - Fiorella Caputo
- Department of Legal and Forensic Medicine, University of Genova, Genova
| | | | - Anna Roncallo
- Department of Legal and Forensic Medicine, University of Genova, Genova
| | - Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova, Genova
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Abstract
Non-variceal upper gastrointestinal bleeding (NVUGIB) is bleeding that develops in the oesophagus, stomach or proximal duodenum. Peptic ulcers, caused by Helicobacter pylori infection or use of NSAIDs and low-dose aspirin (LDA), are the most common cause. Although the incidence and mortality associated with NVUGIB have been decreasing owing to considerable advances in the prevention and management of NVUGIB over the past 20 years, it remains a common clinical problem with an annual incidence of ∼67 per 100,000 individuals in the United States in 2012. NVUGIB is a medical emergency, and mortality is in the range ∼1-5%. After resuscitation and initial assessment, early (within 24 hours) diagnostic and therapeutic endoscopy together with intragastric pH control with proton pump inhibitors (PPIs) form the basis of treatment. With a growing ageing population treated with antiplatelet and/or anticoagulant medications, the clinical management of NVUGIB is complex as the risk between gastrointestinal bleeding events and adverse cardiovascular events needs to be balanced. The best clinical approach includes identification of risk factors and prevention of bleeding; available strategies include continuous treatment with PPIs or H. pylori eradication in those at increased risk of developing NVUGIB. Treatment with PPIs and/or use of cyclooxygenase-2-selective NSAIDs should be implemented in those patients at risk of NVUGIB who need NSAIDs and/or LDA.
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Fukuda N, Ishimura N, Okada M, Izumi D, Mikami H, Okimoto E, Aimi M, Mishiro T, Oshima N, Ishihara S, Kinoshita Y. Mucosal breaks show same circumferential distribution in majority of patients with recurrent reflux esophagitis. Endosc Int Open 2017; 5:E214-E221. [PMID: 28317018 PMCID: PMC5352567 DOI: 10.1055/s-0043-102401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Esophageal mucosal breaks in patients with reflux esophagitis (RE) have a unique circumferential distribution. However, the specific location of mucosal breaks during recurrence of RE remains unclear. We investigated the circumferential distribution of mucosal breaks in patients with recurrent RE and compared their location to that noted at the initial diagnosis. Patients and methods We retrospectively enrolled patients with recurrent RE with Los Angeles (LA) grade A-C who were treated at our University Hospital between July 1996 and June 2014. The circumferential distribution of esophageal mucosal breaks was evaluated at the time of the initial diagnosis and again at the time of recurrence. Information regarding clinical parameters, including proton pump inhibitor administration, presence of hiatal hernia, and mucosal atrophy, was also reviewed. Results A total of 114 patients with recurrent RE were examined during the study period, with a mean duration to recurrence after initial diagnosis of 39.4 months. The majority (72.8 %) had the same LA grade at recurrence. In addition, recurrent mucosal breaks in 96 (84.2 %) patients were observed to have occurred in the same circumferential location as at the initial diagnosis, while those in 18 (15.8 %) were observed in a different location. When recurrent lesions had a different location, the LA grade also tended to be different (P = 0.02). Conclusions We found that most patients with recurrent RE developed lesions in the same circumferential location as noted for the initial lesions. Those in different locations at recurrence were associated with a change in LA grade.
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Affiliation(s)
- Naoki Fukuda
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan,Fukuda Clinic, Ohda, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan,Corresponding author Norihisa Ishimura, MD, PhD Department of Gastroenterology and HepatologyShimane University School of Medicine89-1 Enya-cho, IzumoShimane 693-8501Japan+81-853-20-2190+81-853-20-2187
| | - Mayumi Okada
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Daisuke Izumi
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Hironobu Mikami
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Eiko Okimoto
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Masahito Aimi
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Tsuyoshi Mishiro
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Naoki Oshima
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
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