Cases reported "Mallory-Weiss Syndrome"

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1/11. 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.
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2/11. 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.
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3/11. 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.
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4/11. 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.
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5/11. herpes simplex esophagitis in the immunocompetent host.

    We report here a case of herpes esophagitis with mallory-weiss syndrome in an immunocompetent host. A 26-year-old man was admitted to our hospital because of common cold symptoms and eruptions on the body. On day 2 after hospitalization, the patient showed high-grade fever, odynophagia and hematemesis. Upper gastrointestinal endoscopic examination showed multiple ulcerations throughout the mid- and distal esophagus. Bleeding from a Mallory-Weiss tear was also seen. Follow-up endoscopic examinations showed whitish exudates on day 5. Histological examination of biopsy specimens showed Cowdry type A intranuclear inclusion bodies in epithelial cells. Positive staining of a specific antibody against herpes simplex virus-1 (HSV-1) was seen in the nuclei of esophageal epithelial cells. Primary HSV-1 infection was suspected because ELISA titers of serum IgM antibody against HSV-1 were high and titers of serum IgG antibody against HSV-1 increased from an almost cut-off ratio. A diagnosis of herpes esophagitis in an immunocompetent host was made. Our case is the first report of herpes esophagitis with mallory-weiss syndrome in the immunocompetent host. It is important to remind herpes esophagitis in cases of severe odynophagia even in immunocompetent hosts.
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6/11. Transcatheter embolization for treatment of Mallory-Weiss tears of the esophagogastric junction.

    Five patients with Mallory-Weiss tears of the esophagus and massive uncontrolled upper gastrointestinal bleeding were treated by Gelfoam embolization of the left gastric artery. Four of the five required no further therapy. In one case permanent hemostasis was not achieved due to extension of the tear to branches of the inferior phrenic artery. Since Mallory-Weiss tears are usually self-healing, embolization is potentially the primary treatment modality. Surgery can be reserved for treatment of transmural perforation or recurrent bleeding.
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7/11. The use of endoscopy in the surgical treatment of the mallory-weiss syndrome.

    Fibreoptic endoscopy has provided a new dimension in the diagnosis and management of oesophageal and upper gastrointestinal disorders. Its value as an aid to surgery of the lower oesophagus is demonstrated in a case of the mallory-weiss syndrome.
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8/11. Spontaneous submucosal dissection of the esophagus. A case report.

    A forty year-old Japanese woman complained of slight hematemesis and severe pain on swallowing. Fluoroscopic examination showed typical esophagograms of "double barreled esophagus" or "mucosal stripe". An esophageal ulceration, probably where the dissection re-entered the usual lumen, was endoscopically evident at the lower end of the mucosal bulging. A large, shallow ulcer of unknown cause was also identified in the just anal area from the esophago-gastric junction. She recovered with conservative treatment of fasting, cimetidine and sodium alginate.
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9/11. Mallory-Weiss tear. A complication of cancer chemotherapy.

    Since the original report by Mallory and Weiss of tears in the lower esophagus or cardia of the stomach following alcoholic debauch, there have been many other cases, associated with sundry other causes, described in the literature. Recently, a Mallory-Weiss tear was reported in a patient as a complication of cancer chemotherapy. This article describes two similar cases and suggests that the mallory-weiss syndrome should be included in the differential diagnosis of any patient with epigastric pain, hematemesis, or melena after chemotherapy-induced retching or vomiting.
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10/11. Upper gastrointestinal bleeding in a quadriplegic patient.

    This paper presents an unusual case of gastrointestinal (GI) bleeding which followed a period of nausea and vomiting in a quadriplegic patient in whom endoscopy revealed a tear in the distal esophagus. Similar lesions have been described as the mallory-weiss syndrome. The physiology of vomiting is presented, wherein abdominal muscle contraction plays a partial role. The pathophysiology in the patient who lacks functional abdominal muscles is considered in relation to etiology. It is suggested that mucosal tears similar to those associated with a mallory-weiss syndrome be added to the differential diagnosis of upper GI bleeding in quadriplegic patients.
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