Diagnosis

Differential diagnosis

► Reflux esophagitis

► Typical history of Mallory-Weiss lesion: retching followed by bloodless vomiting, then vomiting of blood

Checklist for endoscopic evaluation

► Identify the bleeding source.

► Endoscopic hemostasis (see p. 155)

► Evaluate response.

► Complete esophagogastroduodenoscopy (EGD) to detect or exclude a concomitant bleeding source.

Endoscopic diagnostic criteria

► Longitudinal blood-stained or bleeding tears (Figs. 3.19, 3.20)

► Located at the gastroesophageal junction

► Frequently posterior

Additional Studies

► Oral contrast examination with a water-soluble medium (en-doscopy is contraindicated in patients with a suspected perforation or if contrast extravasation occurs)

► Chest radiograph (pneumomediastinum is common in Boerhaave syndrome) (Fig. 3.21)

Comments

Treatment for a Mallory-Weiss lesion is described on page 155. Gastroscopy should be repeated after 24 hours. Boerhaave syndrome warrants early, aggressive surgical treatment.

Fig. 3.19 Mallory-Weiss lesion a Forward view

Fig. 3.19 Mallory-Weiss lesion a Forward view

b Retroflexed view

c Close-up view

Fig. 3.20 Mallory-Weiss lesions a Small, blood-tinged mucosal tear in the area of the gastroesophageal junction

Fig. 3.20 Mallory-Weiss lesions a Small, blood-tinged mucosal tear in the area of the gastroesophageal junction

b Mallory-Weiss syndrome

c Close-up view

Fig. 3.21 Pneumomediastinum. Chest radiograph shows definite separation of the mediastinal pleura from the left cardiac border (from: Lange S, Radiologische Diagnostik der Thoraxerkrankung. Stuttgart: Thieme 1996).

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