| disease | Esophageal-cardiac Mucosal Laceration Syndrome |
| alias | Mallory-Weiss Syndrome |
Mallory-Weiss Syndrome refers to a condition characterized by upper gastrointestinal bleeding, primarily caused by tears in the lower esophagus and/or the esophagogastric junction or gastric mucosa due to frequent severe vomiting or other situations that suddenly increase intra-abdominal pressure (such as intense coughing, heavy lifting, or straining during bowel movements).
bubble_chart Auxiliary Examination
1. X-ray double contrast study with air and barium reveals irregular filling defects. Sometimes the barium is located within the ulcer niche, and at other times, filling defects of barium near the bleeding site can be observed.
2. Fiberoptic endoscopy. Emergency endoscopy within 24–48 hours after the onset of a seasonal epidemic shows longitudinal tears in the submucosa at the junction of the esophagus and stomach or in the distal esophagus. These are mostly single but can also be multiple. In mild cases, only a hemorrhagic fissure is visible, with no significant inflammatory reaction in the surrounding mucosa. In severe cases, the fissure is often covered with a blood clot, with fresh bleeding at the edges and surrounding mucosal congestion and edema.
3. Selective celiac angiography can detect bleeding at a rate of 0.5 ml per minute. The contrast agent may be seen extravasating from the junction of the esophagus and stomach, flowing upward or downward along the esophagus, and outlining the esophageal mucosa. This method is suitable for patients with negative results on barium meal or endoscopy. {|102|}
The diagnostic basis includes:
1. Presence of predisposing factors and a clear history leading to increased intra-abdominal pressure.
2. Clinical manifestations of frequent vomiting followed by hematemesis.3. X-ray double-contrast barium enema, selective abdominal stirred pulse angiography, and fiberoptic endoscopy have confirmatory value.
bubble_chart Treatment Measures
Treatment includes conservative methods such as sedation and antiemesis, reducing or avoiding increased abdominal pressure, replenishing blood volume, drug hemostasis, and interventional therapy. If ineffective, surgical ligation of bleeding vessels and suturing of torn membranes should be performed.
It needs to be differentiated from upper gastrointestinal bleeding caused by spontaneous esophageal rupture, peptic ulcer, erosive hemorrhagic gastritis, and rupture of esophageal and gastric varices.
