Mallory-Weiss syndrome. Review of 69 cases.

The records of patients treated for upper gastrointestinal bleeding from 1974 through 1978 were reviewed. Five percent of this group (69 patients) had bleeding due to the Mallory-Weiss syndrome. Only 36 percent of patients had a correct admitting diagnosis. Esophagogastroscopy proved the most reliable diagnostic tool, with 94 percent of 63 patients studied having the diagnosis of Mallory-Weiss laceration confirmed. Initial management was medical in all patients. Twenty-one patients (30 percent) required operative intervention. There was a good correlation between the transfusion requirement and the need for operation. There were two deaths in this series; both were considered preventable. The Mallory-Weiss syndrome is common. Esophagogastroscopy performed early can result in a diagnostic accuracy rate of greater than 90 percent. Aggressive nonsurgical therapy after early diagnosis should continue to reduce the role of operation in the treatment of this condition. However, if bleeding continues after initial medical management, or if bleeding continues after 1,500 ml of blood is required, then surgical therapy should be instituted without delay.