Abstract
We experienced a case of Mallory-Weiss syndrome with deep linear laceration of mucosa (Zeifer III type) and rupture and perforation at the right-side esophago-gastric junction. He was an 84-year-old man. Hematemesis due to the bleeding from the high positioned gastric ulcer seemed to have caused this syndrome.
The depth of laceration caused by this syndrome is generally limited to gastric proper muscle. To reach far to the serosa is rare, so we need to distinguish such cases from spontaneous rupture of the esophagus. We finally diagnosed this case to be Mallory-Weiss syndrome with rupture of the gastric wall for the following reasons : (1) The laceration was Zeifer III, linear type, (2) The abdominal CT findings suggested the muscle wall rupture was at the right and lower gastric side of the E-C junction, and (3) There was more gas shadow in the retroperitoneum than in the lower mediastinum.
We selected conservative treatment for this case, as there was no pleural effusion, no spreading of the gas at the mediastinum, and no systemic inflammatory response finding. He was discharged about 2 weeks offer admission. Generally we may get more satisfactory convalescence for this disease compared with spontaneous rupture of the esophagus.
