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Esophageal Laceration (Mallory-Weiss Syndrome)


Kristle Lee Lynch

, MD, Perelman School of Medicine at The University of Pennsylvania

Reviewed/Revised Mar 2022 | Modified Sep 2022
Topic Resources

An esophageal laceration (Mallory-Weiss syndrome) is a tear that does not penetrate the wall of the esophagus.

  • The tear can be caused by forceful vomiting.

  • Symptoms include blood in vomit.

  • The diagnosis is based on upper endoscopy.

  • When needed, treatment includes measures to stop the bleeding.

A laceration of the lower esophagus and the upper part of the stomach during forceful vomiting, retching, or hiccups is called a Mallory-Weiss tear. The tear may rupture blood vessels, which then bleed. Mallory-Weiss syndrome was initially described in people with an alcohol use disorder, but it can occur in anyone who vomits forcefully.

Did You Know...

  • Forceful vomiting can tear the esophagus.

Symptoms of Esophageal Laceration

The first symptom of Mallory-Weiss syndrome is usually the appearance of bright-red blood in vomit. Vomiting blood is called hematemesis. Some people feel sharp pain in the lower chest when the esophagus tears during vomiting.

Diagnosis of Esophageal Laceration

  • Upper endoscopy

Doctors suspect the diagnosis of Mallory-Weiss syndrome in people who have blood in their vomit after one or more episodes of vomiting. If the amount of bleeding is small, doctors may wait to do testing because the bleeding may stop on its own.

If the bleeding is severe or does not stop on its own, doctors do upper endoscopy. During upper endoscopy, doctors examine the esophagus using a flexible tube called an endoscope Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). In addition to examinations, doctors can use endoscopy to do biopsies and give treatment. Endoscopes... read more . Upper endoscopy allows doctors to see the bleeding source and often treat it at the same time.

If bleeding is rapid or severe, doctors sometimes do angiography. During angiography, doctors use a catheter to inject an artery with a liquid (contrast agent Radiographic Contrast Agents During imaging tests, contrast agents may be used to distinguish one tissue or structure from its surroundings or to provide greater detail. Contrast agents include Radiopaque contrast agents... read more ) that can be seen on x-rays.

Treatment of Esophageal Laceration

  • Measures to stop the bleeding

Most bleeding episodes stop by themselves, but sometimes the doctor must do endoscopy and take measures to stop the bleeding. Measures include using heat to cauterize the bleeding blood vessel, clipping it closed, or injecting a drug into it.

Alternatively, the doctor may inject vasopressin or epinephrine into the bleeding blood vessel during angiography to stop the bleeding.

Surgery to repair the tear is rarely required.

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