ESOPHAGUS : Lacerations and Mallory-Weiss Syndrome
- Lacerations of the esophagus result from external trauma, such as automobile accidents and fall from great heights, and from medical instrumentation.
- Most common cause of laceration is severe vomiting leading to high intraesophageal pressure.
- The diaphragm descends rapidly and a portion of the upper stomach is forced up through the hiatus.
- Forceful stretching may cause mucosal tears, beginning in the gastric epithelium and extending into the esophagus.
Mallory-Weiss Syndrome: Image Link
- In Mallory-Weiss syndrome lacerations are longitudinal tears in the esophagus at the esophagogastric junction, attributed to episodes of excessive vomiting in the setting of toxic gastritis, with failure of lower esophageal sphincter relaxation.
- Lacerations are most frequently seen in alcoholics.
- They may lead to potentially massive hematemesis, inflammation, residual ulcer, mediastinitis, or peritonitis.
- Irregular longitudinal tears span the esophagogastric junction, several milimeter to centimeter in length.
- Lacerations may involve only mucosa or rarely, may penetrate the wall.
- Lacerations account for 5% to 10% of upper gastrointestinal bleeding events.
- Lacerations are not usually fatal, and healing tends to be prompt.