Upper gastrointestinal hemorrhage from a Mallory-Weiss tear associated with an occult Richter's hernia and small bowel obstruction: to see the forest as well as the trees in the emergency department.

Mallory-Weiss tears are a common cause of upper gastrointestinal bleeding and are often associated with vomiting from heavy alcohol ingestion. Other causes of severe emesis can induce a Mallory-Weiss tear, and it may be important to diagnose these conditions so that appropriate therapy can be instituted. We report an unusual condition presenting with a Mallory-Weiss tear, a small bowel obstruction resulting from an occult Richter's hernia, which was not suspected or diagnosed at initial presentation.