A Case Report: Life Saving Mallory-Weiss Syndrome

Abstract

Mallory-Weiss syndrome is characterized by a mucosa rupture on the gastroesophageal junction and usually associated with intense retching, cough, straining, or vomiting. Methanol intoxication is a cause for severe mortality and morbidity. We aimed to emphasize the lifesaving importance of history taking, rapid diagnosis, and treatment for Mallory-Weiss syndrome secondary to methanol intoxication in the present case. A 54-year old male patient admitted to the emergency service by ambulance with the complaint of bloody vomiting. The patient's overall condition was moderate, and he was confused. He was taken into the resuscitation room. The patient was admitted to urgent endoscopy because of active bleeding. It was detected that he had drunk the alcohol that he made at home and presented bloody vomiting when he woke up in the morning. The patient was diagnosed with methanol intoxication and upper gastrointestinal system (GIS) bleeding. After intravenous infusion of 10 mL/kg loading dose of 10% ethanol, infusion continued by 1.5 mL/kg/hour. Urgent hemodialysis was implemented after infusion of 1 mEq/kg NaHCO 3 into the patient presenting severe acidosis. The patient was admitted for further tests and treatment after hemodialysis; he was discharged by cure after nine days. Mallory-Weiss syndrome may develop in GIS bleeding cases triggered by vomiting and have mortal causes. The complaints that start with severe vomiting may be caused by fatal conditions such as methanol intoxication like in the present case. Therefore, a detailed patient history, as well as rapid diagnosis and treatment by emergency clinicians, have vital importance.

Mallory-Weiss Syndrome in Pregnancy

“…The condition can be detected at any age; however, it is 2 to 4 times more common in middle age and male sex. Excessive alcohol intake is detected in 40% to 80% of patients diagnosed with Mallory-Weiss syndrome (Doğan et al, 2019). Mallory-Weiss syndrome has been reported to cause upper gastrointestinal bleeding in approximately 3% to 15% of all cases.…”

“…They considered that upper gastrointestinal endoscopy is not absolutely contraindicated during pregnancy and found to be beneficial in medically stable pregnant patients with significant gastrointestinal bleeding but advocated the use of external cardiotocography and pulse oximetry during the procedure. Indications for surgical intervention without delay are: loss of 30% or more of estimated blood volume in the first 24 hours, need for 1500 ml of blood transfused in 24 hours to maintain hemodynamic stability, bleeding to the point of hypotension or shock and rebleeding during medical therapy (Doğan et al, 2019). has proposes endoscopic procedures and treatment as explained below.…”