1/46. Mallory-Weiss tear following cardiac surgery: transoesophageal echoprobe or nasogastric tube? A case of fatal upper gastrointestinal bleeding from a Mallory-Weiss tear after transoesophageal echocardiography during cardiac surgery is reported. After the echo-cardiographic examination, which is considered a safe procedure, a nasogastric tube was inserted which immediately revealed bright red blood. Eventually the patient lost 9 litres of blood. The role of the echo-probe and the nasogastric tube in causing the Mallory-Weiss tear is discussed. Although this case is not conclusive about the mechanism of oesophageal damage, it is suggested that the safety recommendations for transoesophageal echocardiography also apply for instrumentation of the oesophagus with a nasogastric tube after the transoesophageal echocardiographic examination. ( info) |
| mallory-weiss syndrome (MWS) lesions account for up to 15 per cent of upper gastrointestinal bleeding episodes. Typically these lesions present as a consequence of vomiting that is often associated with alcoholism. Recently other conditions such as pregnancy, migraine, hiatal hernia, gastric ulcer, biliary disease, and various medications have been associated with MWS. We report on a 32-year-old male who developed a MSW lesion after a prolonged period of swimming followed by an extended commercial airplane flight. The hemodynamic changes associated with swimming (increased central distribution of blood volume) and the pressure changes in commercial aircraft (a reduction of 0.3 atmospheres of pressure) are discussed. We conclude that the combination of these factors contributed to the development of a MWS lesion and gastrointestinal bleeding in this patient. We recommend that both air travel and athletic activities be considered as possible contributing factors in the evaluation of the cause of new-onset gastrointestinal bleeding. ( info) |
| There is no consensus as to the best treatment for Mallory-Weiss tears with severe bleeding. Endoscopic ligation is an inexpensive, readily available, and easily learned technique, in contrast to conventional thermocoagulation or hemoclipping. To evaluate the utility of endoscopic ligation, we performed this technique during emergency endoscopy to treat severe bleeding from Mallory-Weiss tears in four patients in our hospital with continuous active bleeding from Mallory-Weiss tears. The patients were all male with an average age of 40.5 years. Symptoms associated with increased intra-abdominal pressure, including retching and vomiting were reported by all patients. The bleeding points were aspirated and controlled by endoscopic ligation, and complete hemostasis was achieved in all cases. We conclude that endoscopic ligation is easy to perform and may provide an alternative treatment for severe bleeding from Mallory-Weiss tears. ( info) |
4/46. Endoscopic ligation for patients with active bleeding Mallory-Weiss tears. BACKGROUND: Only a few patients with active nonesophageal variceal upper gastrointestinal bleeding have been treated with endoscopic ligation. To further address this issue, four patients with active bleeding Mallory-Weiss tears who underwent endoscopic band ligation are presented. patients and methods: Endoscopic ligation was performed in four patients with a median age of 52 years (range, 40-93 years) after a diagnosis of active bleeding Mallory-Weiss tears (MWTs). A 45-year-old man with massive persistent upper gastrointestinal bleeding as a cause of a MWT underwent therapeutical endoscopic band ligation after an unsuccessful endoscopic injection trial. On the contrary, injection therapy should have been performed on a 93-year-old woman with multiple myeloma because of an actively bleeding MWT caused by the fibrotic tissue after an unsuccessful endoscopic ligation trial, although her other actively bleeding MWT lesion had been ligated successfully. RESULTS: After endoscopic ligation, all patients achieved complete hemostasis, and rebleeding did not occur. They were discharged without complications after a control endoscopy. CONCLUSIONS: Endoscopic ligation can be performed easily and without any complications such as perforation or delayed hemorrhage in patients with actively bleeding nonfibrotic MWTs. ( info) |
5/46. Two cases of submucosal haematoma of the oesophagus and Mallory-Weiss tear. Submucosal haematoma of the oesophagus is an uncommon condition which may be under-recognised. Presentation may be with chest pain, dysphagia or haematemesis. endoscopy, CT scan, barium meal or a combination of these modalities makes the diagnosis. Most patients make a full recovery. ( info) |
6/46. Esophageal intramural pseudodiverticulosis with mallory-weiss syndrome: report of a case. A 62-year-old man with a chief complaint of coughing up blood was revealed to have mallory-weiss syndrome with arterial bleeding by gastrointestinal endoscopy at the esophagogastric junction, and two teardrop-shaped fissures were found longitudinally extending into the muscle layer. Endoscopic treatment with ethanol injection and the administration of a thrombin solution spray failed to control the arterial bleeding. hemostasis was finally archived by suturing the fissures under an open laparotomy. A postoperative barium esophagogram showed multiple flask-shaped outpouchings in the thoracic esophagus, and a diagnosis of esophageal intramural pseudodiverticulosis (EIPD) was thus made. EIPD is usually accompained with esophageal strictures but esophageal bleeding is rare. ( info) |
| Six patients (three women and three men) who had upper gastrointestinal hemorrhage due to mallory-weiss syndrome are described. Retching was the most common precipitating factor (5/6) followed by vomiting (2/6). Basic underlying causes for either retching or vomiting were probable excess alcohol consumption (3/6), side-effects of oral or parentral medication (2/6) and over-indulgence in eating after partial gastrectomy (1/6). The two most important factors leading to confirmation of the diagnosis were: 1. history of events prior to the onset of upper gastrointestinal hemorrhage and 2. early panendoscopy. One noted feature of the present series is the high incidence of other silent co-existing pathological lesions at the time of endoscopic examination. Upper gastrointestinal hemorrhage was characterized as mild to moderate (300-500 cc.) in three patients and moderate to severe (1,000-2,000 cc.) in another three patients. All recovered under medical management and none required surgical intervention. It is becoming increasingly evident that such a benign outcome in mallory-weiss syndrome is more common than previously recognized. ( info) |
| mallory-weiss syndrome (MWS) is a well-defined entity in clinical medicine. However, the development of such a syndrome as a result of overpressure barotrauma of the stomach after repeated shallow-water scuba dives is rare. Also rare is the delayed onset of the MWS, approximately 20 hours after the dives. The causes of development of MWS in connection with scuba diving are discussed. The main causes seem to be the repeated changes of gas volume in the stomach with subsequent pressure forces toward the cardia in the course of repeated dives. The possibility of serious diving accident due to overpressure barotrauma of gastro-intestinal system is also pointed out. ( info) |
9/46. Mallory - weiss tear complicating intraoperative transesophageal echocardiography. A Mallory - Weiss tear occurred as a complication of intraoperative transesophageal echocardiography carried out in a 62-year-old man who underwent coronary artery bypass grafting. Left ventricular function was monitored in the transgastric short-axis view. Postoperative esophagogastroscopy revealed a Mallory - Weiss tear at the gastroesophageal junction and erosions in the cardia, presumably secondary to contact pressure by the echoprobe and ultrasonic thermal injury. When not actively imaging, the echoprobe should be left free in the esophagus with the acoustic power off. ( info) |
| The majority of patients with scleroderma have gastrointestinal involvement, and a few experience gastrointestinal hemorrhage, however, gastrointestinal hemorrhage due to mallory-weiss syndrome is very rare. We report upon a 24-year-old pregnant woman with scleroderma who had gastrointestinal hemorrhage due to mallory-weiss syndrome. ( info) |