P3333 - Tearing the Norm: Mallory-Weiss Unveiled - Dysphagia as a Surprising Presentation

Mohammad Nabil Rayad, MD¹, Noreen Mirza, MD¹, Vikramjit S. Purewal, DO², Dema Shamoon, MD¹, Muhammad Hussain, MD¹, Yatinder Bains, MD^1
1Saint Michael's Medical Center, New York Medical College, Newark, NJ; ²Mountain Vista Medical Center, Mesa, AZ

Introduction: Mallory-Weiss tear (MWT) is a a tear in the lining of the gastroesophageal junction caused by excessive pressure on the area due to retching, coughing or vomiting. It can account for around 5-15% of upper gastrointestinal bleeding cases. Herein, we present a rare case of MWT presenting as dysphagia due to massive blood clot.

Case Description/Methods: A 47 year-old-male with a history of diabetes and alcohol use disorder (AUD) presented to the ED for evaluation of difficulty swallowing for the last two days. He had one episode of hematemesis two days ago for which he never went to the hospital for evaluation. Vital signs were normal and physical examination was significant for epigastric tenderness. Initial hemoglobin was 7.3 g/dL. The electrolytes, kidney function were normal and LFTs were mildly elevated with normal bilirubin and PT/INR. Computerized tomography (CT) scan showed a mildly dilated esophagus with a 3.6x2.3x5cm soft tissue density in the mid thoracic esophagus. Emergent esophagogastroduodenoscopy (EGD) was done for foreign body removal and revealed a web, esophagitis, three esophageal ulcers with two actively bleeding and a large clot was seen surrounding one proximal ulcer which was removed by cold snare. The actively bleeding ulcers were treated with coagulation and hemostatic clips. His dysphagia resolved post-procedure.

Discussion: MWT commonly presents as hematemesis and rarely presents as dysphagia due to esophageal obstruction. If it presents as such, immediate medical attention is required. Diagnosis is usually made through a combination of imaging studies; however, endoscopy allows for visualization of tears and evaluation of the extent of obstruction. Treatment of MWT depends on severity of the tear and endoscopic therapy via cauterization or clips are used to promote hemostasis. In rare cases where endoscopic therapy fails, surgery may be required. MWT should not only be a differential in a patient with upper GI bleed but should also be included when evaluating a patient with dysphagia.



Disclosures:


Mohammad Nabil Rayad, MD¹, Noreen Mirza, MD¹, Vikramjit S. Purewal, DO², Dema Shamoon, MD¹, Muhammad Hussain, MD¹, Yatinder Bains, MD¹. P3333 - Tearing the Norm: Mallory-Weiss Unveiled - Dysphagia as a Surprising Presentation, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.