Esophageal Tears and Perforations
Alexandros D. Polydorides, MD, PhD
Key Facts
Terminology
MWT: Spontaneous mucosal gastroesophageal tear
BS: Spontaneous transmural esophageal perforation
Etiology/Pathogenesis
Alcohol or salicylate use/abuse, hiatal hernia, portal hypertension, coagulopathy
Clinical Issues
MWT accounts for 5-15% of upper GI hemorrhages
Preceded by nausea, severe vomiting (30%)
Followed by hematemesis (85-100%), shock (˜ 10%)
Macroscopic Features
Single (< 10% multiple) longitudinal lacerations
Cleft-like mucosal defects, average length 1.5-2 cm
Right posterior distal esophagus/proximal stomach
˜ 75% in cardia only, associated with hiatus hernia
Endoscopy: Diagnostic modality of choice
Most perforations: Left side of distal esophagus
 Gross pathology photograph shows a longitudinal laceration  straddling the gastroesophageal junction and extending proximally to distal esophagus. (Courtesy H. Appelman, MD.) |
 Esophagram in a patient with vomiting and chest pain shows an esophageal rupture with extravasation of contrast  from the esophagus  . The stomach  can also be seen. |
TERMINOLOGY
Abbreviations
Mallory-Weiss tear (MWT)
Mallory-Weiss syndrome (MWS)
Boerhaave syndrome (BS)
Definitions
MWT: Mucosal gastroesophageal tear/laceration
MWS: Painless upper GI bleeding from MWT
BS: Spontaneous transmural esophageal perforation
ETIOLOGY/PATHOGENESIS
Environmental Exposure
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