Mallory—Weiss syndrome

Forceful vomiting may produce a mucosal tear at the cardia rather than a full perforation of the oesophagus. The mechanism of injury is different. In Boerhaave’s syndrome vomiting occurs against a closed glottis and pressure builds up in the oesophagus. In the Mallory—Weiss syndrome vigorous vomit­ing produces a vertical split which is in the gastric mucosa immediately below the squamocolumnar junction at the cardia in 90 per cent of cases. In only 10 per cent is the tear in the oesophagus (Fig. 50.20). The condition presents with haematemesis. Usually the bleeding is not severe, but endo­scopic injection therapy may be required for the occasional case with severe bleeding. Surgery is rarely required.