A Study of Mallory-Weiss Syndrome Secondary to Upper Gastrointestinal Bleeding

Yoshihiro Inoue, Yasuhisa Fujino, Makoto Onodera, Satoshi Kikuchi, Masayuki Sato, Hisaho Sato, Hironobu Noda, Masahiro Kojika, Yasushi Suzuki, Shigeatsu Endo

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Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka-shi, Japan.

DOI: 10.4236/ojcd.2014.43021                

Abstract

Background: In Mallory-Weiss Syndrome (MWS), vomiting causes the mucous membrane and submucosa near the esophagogastric mucosal junction to tear and bleed. Thus, MWS can arise after heavy drinking and as a complication of endoscopic upper gastrointestinal examinations or procedures. However, there has been no report of MWS secondary to upper gastrointestinal bleeding thus far. Case Subjects: Of 79 MWS cases over a 10-year period from 2002 to 2011, we identified and studied 6 cases, in which MWS was probably caused by another lesion causing upper gastrointestinal bleeding. Results: There were 2 cases, each of gastric ulcers, duodenal ulcers, and varicose veins. In 3 cases, MWS was discovered during treatment of the primary lesion and was simultaneously treated. In the other 3 cases, patients were treated for MWS according to endoscopic diagnosis, and the primary lesion was overlooked; in these cases, the primary lesion was identified and treated after the bleeding recurred. One patient with cirrhosis died of hepatic failure. Conclusion: Care should be taken when dealing with MWS because it can occur as a result of vomiting caused by hematemesis or as a complication of endoscopic examination and treatment. When assessing MWS, other hemorrhagic lesions may be overlooked.

Keywords

Mallory-Weiss Syndrome, Upper Gastrointestinal Bleeding, Endoscopic Hemostasis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Mallory, G.K. and Weiss, S. (1929) Hemorrhages from Lacerations of the Cardiac of the Stomach Due to Vomiting. American Journal of the Medical Sciences, 178, 506-515. http://dx.doi.org/10.1097/00000441-192910000-00005
[2]	Sugawa, C. and Masuyama, H. (1986) Mallory-Weiss Syndrome—A Changing Clinical Picture of 310 Patients. Japanese Journal of Gastroenterology, 83, 619-624.
[3]	Kitagawa, T., Takano, H., Soma, M., Muto, E. and Takeda, S. (1994) Clinical Study of Mallory-Weiss Syndrome in the Aged Patients over 75 Year-Mainly Five Cases Induced by the Endoscopic Examination. Japanese Journal of Geriatrics, 31, 374-379. http://dx.doi.org/10.3143/geriatrics.31.374
[4]	Kasamaki, S., Okada, T. and Okada, S. (2010) Nine Cases of Gastric Mucosal Injury Due to Mallory-Weiss Syndrome during Percutaneous Endoscopic Gastrostomy (PEG). Gastroenterological Endoscopy, 52, 1691-1697.
[5]	Nishida, Y., Hamaji, M., Sakabuchi, H., Miyazaki, T., Kuhara, A., Ishida, M. and Ito, T. (1999) Mallory-Weiss Syndrome with Colonic Lavage—A Case Report. The Japanese Journal of Gastroenterological Surgery, 32, 997-1001. http://dx.doi.org/10.5833/jjgs.32.997
[6]	Inoue, Y. (1994) Mallory-Weiss Syndrome. Japanese Journal of Acute Medicine, 18, 1330-1332.
[7]	Zeifer, H.D. (1961) Mallory-Weiss Syndrome. Annals of Surgery, 154, 956-960.
[8]	Watts, H.D. (1976) Mallory-Weiss Syndrome Occurring as a Complication of Endoscopy. Gastrointestinal Endoscopy, 22, 171. http://dx.doi.org/10.1016/S0016-5107(76)73737-4
[9]	Baker, R.W., Spiro, A.H. and Trnka, Y.M. (1982) Mallory-Weiss Tear Complicating Upper Endoscopy: Case Reports and Review of the Literature. Gastroenterology, 82, 140-142.
[10]	Inoue, Y., Fujino, Y., Onodera, M., Kikuchi, S., Kojika, M. and Endo, S. (2012) Emergency Endoscopy for Upper Gastrointestinal and Non-Variceal Bleeding. Japanese Journal of Gastroenterology, 55, 545-552.