Follow-up
Further Outpatient Care
Mallory-Weiss tears almost never rebleed; thus, follow-up is not usually indicated.
Next:
Further Inpatient Care
Two types of endoscopic therapy can be used to control severe bleeding in patients who are hemodynamically unstable because of bleeding from a Mallory-Weiss tear.
-
Injection therapy is favored as the first-line therapy by most endoscopists for control of bleeding esophageal lesions because of its ease of use, safety, and cost. Typically, the injections are made 3-5 mm apart circumferentially around the site of bleeding in 4 areas. The chemical agents used for injection therapy include dilute epinephrine, sodium morrhuate, ethyl alcohol, or sodium tetradecyl sulfate.
-
Heater probe or bipolar coagulation therapies use electrical current supplied by catheters that can be inserted into an endoscope to control bleeding. Approximately 20 joules (10-15 Watts) of current are used per individual pulse, and treatment is complete when the bleeding has ceased. The current is usually delivered in repeated time-limited pulses.
Evaluate the underlying cause of vomiting.
Previous
Next:
Transfer
Transfer children with severe uncontrolled bleeding to a tertiary care hospital with an in-house pediatric gastroenterologist.
Previous
Next:
Deterrence/Prevention
Avoid and treat causes of underlying vomiting and retching.
Previous
Next:
Complications
Complications include the following:
-
Anemia
-
Dehydration
Previous
Next:
Prognosis
Prognosis is extremely good in children, with a less than 0.01% mortality rate. These tears almost always respond to conservative therapy and supportive care. [16]
Previous
Media Gallery
-
Mallory-Weiss tear. Typical longitudinal mucosal tear with overlying fibrinous exudate extending from the distal esophagus to the gastric cardia. Courtesy of C.J. Gostout, MD.
-
Mallory-Weiss tear. Retroflexed view of the cardia showing the typical location of the tear with a clean base.
of
2
