Mallory Weiss. El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Mallory Weiss Tear. This 58 year-old female, 3 days previously had hematemesis.

Video Endoscopic Sequence 1 of 2.

Mallory Weiss Tear

This 58 year-old female, 3 days previously had hematemesis.

 

 For more endoscopic details, download the video clip by
 clicking on the endoscopic image. Wait to be downloaded
 complete then Press Alt and Enter for full screen. All
 endoscopic images shown in this Atlas contain video clips.
 We recommend seeing the video clips in full screen mode.
A Hiatal Hernia is seen with longitudinal tear. Hiatal hernia has been found in 40 to 100 percent of patients with Mallory-Weiss tears and has been considered by some to be a necessary predisposing factor. It has been proposed that, in hiatus hernia, a higher pressure gradient develops in the hernia compared with that in the rest of the stomach during retching, thereby increasing the potential for mucosal laceration. Gastroesophageal tears may also be more likely to occur when the upper esophageal sphincter does not relax during vomiting.

Video Endoscopic Sequence 2 of 2.

A Hiatal Hernia is seen with longitudinal tear.

 Hiatal hernia has been found in 40 to 100 percent of
 patients with Mallory-Weiss tears and has been considered
 by some to be a necessary predisposing factor. It has been
 proposed that, in hiatus hernia, a higher pressure gradient
 develops in the hernia compared with that in the rest of the
 stomach during retching, thereby increasing the potential
 for mucosal laceration. Gastroesophageal tears may also
 be more likely to occur when the upper esophageal
 sphincter does not relax during vomiting.

 Mallory-Weiss syndrome is characterized by longitudinal
 mucosal lacerations (intramural dissections) in the distal
 esophagus and proximal stomach, which are usually
 associated with forceful retching. The lacerations often
 lead to bleeding from submucosal arteries. Since the initial
 description in 1929 by Mallory and Weiss in 15 alcoholic
 subjects.

Mallory Weiss Syndrome. This 42 year-old male, two days previously has been drinking alcoholic beverages, started vomiting, immediately patient initiates with hematemesis follow with melena.

Video Endoscopic Sequence 1 of 3.

Mallory Weiss Syndrome

 This 42 year-old male, two days previously has been
 drinking alcoholic beverages, started vomiting,
 immediately patient initiates with hematemesis follow
 with melena.

The image displays a blood clot that covers the mucosal tear.

 The classic presentation consists of an episode of hematemesis
 following a bout of retching or vomiting, although this
 presentation may be less common than previously thought.

 
Retroflexed image. Pathophysiology. A Mallory-Weiss tear (MWT) likely occurs as a result of a large, rapidly occurring, and transient transmural pressure gradient across the region of the gastroesophageal junction. Acute distension of the nondistensible lower esophagus can also produce a linear tear in this region.

Video Endoscopic Sequence 2 of 3.

Retroflexed image

Pathophysiology

 A Mallory-Weiss tear (MWT) likely occurs as a result of
 a large, rapidly occurring, and transient transmural
 pressure gradient across the region of the
 gastroesophageal junction. Acute distension of the
 nondistensible lower esophagus can also produce a linear
 tear in this region.

 With a rapid rise in intragastric pressure due to
 precipitating factors, such as retching or vomiting, the
 transmural pressure gradient increases dramatically across
 the hiatal hernia, which abuts a low intrathoracic pressure
 zone. If the shearing forces are high enough, a longitudinal
 laceration eventually occurs. Within the hernia, the tear is
 more likely to involve the lesser curvature of the gastric
 cardia, which is relatively immobile compared to the
 remainder of the stomach.

 Another potential mechanism for MWTs is the violent
 prolapse or intussusception of the upper stomach into the
 esophagus, as can be witnessed during forceful retching at
 endoscopy.
The Hiatus Hernia displays the blood clot.

Video Endoscopic Sequence 3 of 3.

The Hiatus Hernia displays the blood clot

 

  •  Bleeding from MWTs stops spontaneously in 80-90% of patients. With conservative therapy, most tears heal uneventfully within 48 hours. Thus, a MWT can easily be missed if endoscopy is delayed.
  • The degree of blood loss varies. Earlier studies reported that the proportion of patients requiring blood transfusions was 40-70%. These figures do not seem to be the trend today and are probably significantly lower.
  • Hemodynamic instability and shock may occur in up to 10% of patients. In one series, mortality as high as 8.6% was attributed to MWTs. Current clinical experience suggests a significantly lower mortality rate from MWTs.

 
A 68 year-old female one week previously she presented a history of severe vomiting, which later had melena. The endoscopy displayed here is performed one week after the inicial symtoms. A Mallory Weiss tear was showed, presented as a linear ulcer. The Mallory Weiss tear is localized to the gastric side side of the squamocolumnar junction or extends across the z line into the esophagus.

Video Endoscopic Sequence 1 of 3.

 A 68 year-old female, one week previously presented a
 history of severe vomiting, which later had melena.
 
 The endoscopy displayed here is performed one week
 after the inicial symtoms. A Mallory Weiss tear was
 showed, presented as a linear ulcer.
 The Mallory Weiss tear is localized to the gastric side
 side of the squamocolumnar junction or extends across
 the z line into the esophagus.

 The original description by Mallory and Weiss in 1929 involved
 patients with persistent retching and vomiting following an
 alcoholic binge. However, Mallory-Weiss syndrome may occur
 after any event that provokes a sudden rise in intragastric
 pressure or gastric prolapse into the esophagus.
 Pathophysiology: A Mallory-Weiss tear (MWT) likely occurs
 as a result of a large, rapidly occurring, and transient transmural
 pressure gradient across the region of the gastroesophageal
 junction. Acute distension of the nondistensible lower esophagus
 can also produce a linear tear in this region.
 With a rapid rise in intragastric pressure due to precipitating
 factors such as retching or vomiting, the transmural pressure
 gradient increases dramatically across the hiatal hernia, which
 abuts a low intrathoracic pressure zone. If the shearing forces are
 high enough, a longitudinal laceration eventually occurs. Within the
 hernia, the tear is more likely to involve the lesser curvature of the
 gastric cardia, which is relatively immobile compared to the
 remainder of the stomach.
 Another potential mechanism for MWTs is the violent prolapse or
 intussusception of the upper stomach into the esophagus, as can
 be witnessed during forceful retching at endoscopy.
 
 
                                           
                                          Medline.
The Mallory Weiss tear is an acute lesion that, when viewed soon after the tear occurs, has the appearance of an edematous and irregular split in the mucosa. Bleeding is usually multifocal, but can arise from an exposed intramural artery branching off the left gastric artery.

Video Endoscopic Sequence 2 of 3.

 Same case as above, the retroflexed maneuver displays
 a linear ulcer at the gastroesophageal junction.

 The Mallory Weiss tear is an acute lesion that, when
 viewed soon after the tear occurs, has the appearance of
 an edematous and irregular split in the mucosa.  
 Bleeding is usually multifocal, but can arise from an
 exposed intramural artery branching off the left gastric
 artery.
The classic presentation for the Mallory Weiss tear is a sequence of events beginning with nausea and vomiting followed soon by hematemesis.

Video Endoscopic Sequence 3 of 3.

 The classic presentation for the Mallory Weiss tear is
 a sequence of events beginning with nausea and
 vomiting followed soon by hematemesis.
   

A 43 year-old man who had been drinking alcoholic beverages, after that, he undergone vomiting and bleeding. The video clip displays a hiatal hernia, reflux esophagitis and a blood clot that covers the mucosal tear.

 
 A 43 year-old man who had been drinking alcoholic
 beverages, after that, he undergone vomiting and bleeding.
 The video clip displays a hiatal hernia, reflux esophagitis
 and a blood clot that covers the mucosal tear.

 A history of heavy alcohol use leading to vomiting has been
 noted in 40 to 80 percent of patients with Mallory-Weiss
 syndrome in most series. The bleeding is usually more
 severe when Mallory-Weiss tears are associated with
 portal hypertension and esophageal varices. Occasionally,
 patients give a history of ingestion of aspirin or
 nonsteroidal antiinflammatory drug. 
Mallory Weiss Syndrome, 34 year-old male physician who had been drinking alcoholic beverages and started vomiting.,immediately, after that. The patient had an upper gastrointestinal bleeding.

Mallory Weiss Syndrome.

 34 year-old male physician who had been drinking alcoholic
 beverages and started vomiting, immediately, after that,
 the patient had an upper gastrointestinal bleeding.
 
54 year-old female, who had induced vomiting a day before because of a feeling of malaise. Melena was observed. Her hemoglobin was 8.1 mg/dl. She underwent upper endoscopy, and a gastroesophageal tear was found at the gastroesophagic junction.

Video Endoscopic Sequence 1 of 3.

 54 year-old female, who had induced vomiting a day before
 because of a feeling of malaise. Melena was observed.
 Her hemoglobin was 8.1 mg/dl.
 She underwent upper endoscopy, and a gastroesophageal
 tear was found at the gastroesophagic junction.
 

The image and the video display a ulcer with a blood clot the endoscope is retroflexed.

Video Endoscopic Sequence 2 of 3.

 The image and the video display a ulcer with a blood clot
 the endoscope is retroflexed.
The blood clot is observed in retroflexed maneuver.

Video Endoscopic Sequence 3 of 3.

 The blood clot is observed in retroflexed maneuver.

 How frequently a Mallory-Weiss tear occurs without
 bleeding cannot be determined with any certainty. It is
 highly likely that the condition occurs in a less severe form
 more frequently than is recognized.
Mallory-Weiss tears occurring during the course of upper gastrointestinal endoscopy are apparently rare, Iatrogenic Mallory-Weiss tears are rare and generally have a benign course. They tend to occur mostly in patients who have experienced excessive retching or struggling during endoscopy. Mallory-Weiss tears complicating endoscopy occur especially in elderly, female patients with hiatal hernias. The importance of admitting patients with this complication to hospital for overnight observation is recommended in view of the possible development of haemorrhage or perforation..

Mallory-Weiss tears occurring during endoscopy

 Mallory-Weiss tears occurring during the course of upper
 gastrointestinal endoscopy are apparently rare, Iatrogenic
 Mallory-Weiss tears are rare and generally have a benign
 course. They tend to occur mostly in patients who have
 experienced excessive retching or struggling during
 endoscopy. Mallory-Weiss tears complicating endoscopy
 occur especially in elderly, female patients with hiatal
 hernias. The importance of admitting patients with this
 complication to hospital for overnight observation is
 recommended in view of the possible development of
 haemorrhage or perforation.

 

 Pubmed                  Pubmed

 
This 54 year-old female, had some episodes of vomiting presented with hematemesis, she was diagnostic as having Mallory Weiss tear, after that the patient presented intermittent melena during a one week, She was referred to our endoscopic unit for evaluation.

Video Endoscopic Sequence 1 of 9.

Mallory-Weiss Syndrome

 This 54 year-old female, had some episodes of vomiting
 presented with hematemesis, she was diagnostic as having
 Mallory Weiss tear, after that the patient presented
 intermittent melena during a one week, She was referred
 to our endoscopic unit for evaluation.

 
An adhered blood clot is observed of where it is the exact site of bleeding.

Video Endoscopic Sequence 2 of 9.

An adhered blood clot is observed of where it is the exact site of bleeding.

 
At the gastric fundus, there are rest of dark blood.

Video Endoscopic Sequence 3 of 9.

At the gastric fundus, there are rest of dark blood.

 
There is a slight bleeding around of the blood clot.

Video Endoscopic Sequence 4 of 9.

There is a slight bleeding around of the blood clot

Mallory APC5

Video Endoscopic Sequence 5 of 9.

 
Immediately above of the clot there is an erosion in phase of healing.

Video Endoscopic Sequence 6 of 9.

 Immediately above of the blood clot there is an erosion in phase of healing.

 
Mallory APC7

Video Endoscopic Sequence 7 of 9.

 
The hemostatic therapy with argon plasma has been initiated.

Video Endoscopic Sequence 8 of 9.

The hemostatic therapy with argon plasma has been initiated
The hemostatic treatment was carried out ambulatorily, the patient was handled with proton pump inhibitors evolving without newness.

Video Endoscopic Sequence 9 of 9.

 The hemostatic treatment was carried out ambulatorily, the
 patient was handled with proton pump inhibitors evolving
 without newness.