Approach Considerations
No specific laboratory tests are indicated for determining the etiology of a Mallory-Weiss tear. Coagulation parameters should be assessed. Obtain a CBC count to determine the severity of bleeding.
No specific imaging studies exist that can positively identify an esophageal tear. Several retrospective studies have demonstrated that barium esophagography may reveal small esophageal hematomas or thick streaks where the barium becomes trapped in the tear. However, only 20% of patients with a Mallory-Weiss tear had positive radiologic findings, and, in all cases, an upper endoscopy was performed for definitive diagnosis.
The hallmark of a Mallory-Weiss tear is the visual appearance of one or more linear bleeding lesions at or just proximal to the esophagogastric junction. Visual inspection of the esophagus, stomach, and duodenum is essential in the evaluation of a child presenting with hematemesis.
Esophagogastroduodenoscopy
Upper endoscopy is the diagnostic tool of choice for esophageal tears. [11] Perform endoscopy within 24 hours of the bleeding episode. In cases of severe bleeding with hemodynamic instability, the patient should be stabilized prior to performing endoscopy. Note the following:
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Tears visualized within 24 hours usually have a soft, fresh, mounded, brownish-red appearance on the surface of the mucosa.
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After 48-72 hours, the tear looks like a mucosal cleft that may be surrounded by erythematous mucosa.
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By 96 hours, most Mallory-Weiss lesions are well-healed and may be difficult to visualize.
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Mallory-Weiss tears can heal quickly after the cessation of vomiting and retching and may not be diagnosed if performance of the upper endoscopy is delayed.
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Mallory-Weiss Syndrome. Typical longitudinal mucosal tear with overlying fibrinous exudate extending from the distal esophagus to the gastric cardia. Courtesy of C.J. Gostout, MD.
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Mallory-Weiss Syndrome. Retroflexed view of the cardia showing the typical location of the tear with a clean base.
