Severe hemorrhage secondary to iatrogenic Mallory Weiss tear caused by retching during endoscopy: a rare case report

Mallory-Weiss tears (MWT), a common cause of upper gastrointestinal bleeding, are longitudinal mucosal tears around the gastroesophageal junction [5] (GOJ), typically caused by repetitive retching following excessive alcohol intake [2]. However, an iatrogenic MWT, resulting in a potentially profuse bleed, is rare with a reported incidence of 0.07%-0.49% [4]. It can occur secondary to retching during Oesophago-gastro-duodenoscopy (OGD) [1]. It is, therefore, imperative for endoscopists to recognize and treat such MWTs promptly. An eighty-three-year-old man presented with intermittent epigastric pain and syncope associated with malaena. His relevant history included a hiatal hernia and ischaemic heart disease, for which he was on Aspirin. With a significant drop in haemoglobin and a rise in urea, an upper gastrointestinal bleed was suspected and an OGD was performed. This showed a Forrest Class-IIa ulcer at the antrum, which was treated with adrenaline and coagulation, using a bi-polar gold probe. During this procedure, patient retched heavily and developed a 12mm, linear, superficial tear at the GOJ involving the cardia with profuse bleeding. Seven large haemo-clips were applied to close off this tear and secure haemostasis. He recovered uneventfully with omeprazole infusion and anti-emetics. He was discharged with a planned outpatient OGD to ensure healing. Iatrogenic MWTs are quite rare and usually self-limited [1] but can cause significant bleeding [4], which require immediate endotherapy [3] and post-procedure care. Hiatal hernia [2], advanced age [2], use of anti-platelets [2], insufflation of too much gas, and retching during the procedure [1], are risk factors that can predispose to iatrogenic MWTs, which can cause bleeding and perforation [5].

Publication History

Article published online:
27 March 2025

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