The Mallory-Weiss syndrome.

During a 41/2-year period, 1970-74, 174 patients with upper gastro-intestinal bleeding were admitted to the Department of Surgical Gastroenterology, Rigshospitale, Copenhagen, Denmark. In 11, a Mallory-Weiss syndrome was diagnosed. In 10, the diagnosis was made by means of gastroscopy, and in 1 patient at operation. It was not possible to make the diagnosis by means of X-ray examination of the oesophagus or the stomach. In one patient, a hiatal hernia was found. The etiology was violent and repeated vomiting. In 9 of the cases the syndrome was cuased by chronic alcoholic debauch and migraine. In 1 patient, the disease was caused by an abrupt external trauma of the abdomen after a traffic accident. In the last patient, the cause of the disease was uncertain. The treatment was entirely conservative, i.e. blood replacement, in 10 of the patients. The bleeding stopped after this treatment, and it was not necessary to use a Sengstaken-Blakemore tube, nor was a later surgical exploration needed, except in one patient in whom an emergency operation was required because of extensive and persistent bleeding. At operation, 3 mucosal tears were sutured. At the time of discharge, all 11 patients were feeling well. Based on the present material, and cases reported in the literature, we have concluded that emergency gastroscopy is the most reliable diagnostic measure in patients with the Mallory-Weiss syndrome. The treatment ought to be as conservative as possible with replacement of the blood, and surgical intervention should be performed only in the few patients with incontrollable bleeding.