Location of Mallory-Weiss Tear
A Mallory-Weiss tear is typically located posteriorly across the gastroesophageal junction (option c). 1, 2
Anatomical Location and Characteristics
- Mallory-Weiss tears are mucosal lacerations that occur at or near the gastroesophageal junction, most commonly on the posterior aspect 1, 2
- These tears are frequently found on the right lateral wall (2-4 o'clock position) of the esophagus aligned with the lesser curvature of the stomach 2
- The tears typically extend longitudinally across the gastroesophageal junction, rather than being confined to either the esophagus or stomach alone 3
- Longer lacerations that extend from the esophagus into the gastric cardia are associated with a higher risk of significant bleeding requiring blood transfusion 2
Clinical Significance
- Mallory-Weiss tears account for approximately 3-10% of cases of upper gastrointestinal bleeding 3
- They are often associated with forceful retching or vomiting, which causes a sudden increase in intra-abdominal pressure 1
- The classic presentation involves non-bloody emesis followed by hematemesis, though this pattern is seen in only about 29% of cases 4
- Most tears (90%) stop bleeding spontaneously and require only conservative management 2, 5
Diagnostic Considerations
- Upper gastrointestinal endoscopy is the gold standard for diagnosis, revealing a longitudinal mucosal tear at the gastroesophageal junction 3
- In the Rockall scoring system for risk assessment of upper GI bleeding, Mallory-Weiss tears are categorized as low-risk lesions with an excellent prognosis 1
- Endoscopy can also identify other potential bleeding sources, which are present in approximately 35% of patients with Mallory-Weiss tears 4
Treatment Approaches
- Most Mallory-Weiss tears require no intervention beyond hemodynamic support 5
- For active bleeding, endoscopic treatments include injection therapy, argon plasma coagulation, hemoclip placement, or band ligation 1, 5
- Band ligation appears to be the most effective procedure for achieving primary hemostasis and preventing recurrent bleeding 3
- Proton pump inhibitors are commonly used, though their efficacy specifically for Mallory-Weiss tears is not well-established in literature 3
Understanding the posterior location across the gastroesophageal junction is crucial for proper identification and management of Mallory-Weiss tears during endoscopic procedures.