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Mallory-Weiss syndrome: possible link to water immersion and subsequent air flight
A J Pikarsky1, G Zamir, H Belzberg
1Department of Surgery, Hadassah University Hospital, Jerusalem, Israel.
Abstract:
Mallory-Weiss Syndrome (MWS) lesions account for up to 15 per cent of upper gastrointestinal bleeding episodes. Typically these lesions present as a consequence of vomiting that is often associated with alcoholism. Recently other conditions such as pregnancy, migraine, hiatal hernia, gastric ulcer, biliary disease, and various medications have been associated with MWS. We report on a 32-year-old male who developed a MSW lesion after a prolonged period of swimming followed by an extended commercial airplane flight. The hemodynamic changes associated with swimming (increased central distribution of blood volume) and the pressure changes in commercial aircraft (a reduction of 0.3 atmospheres of pressure) are discussed. We conclude that the combination of these factors contributed to the development of a MWS lesion and gastrointestinal bleeding in this patient. We recommend that both air travel and athletic activities be considered as possible contributing factors in the evaluation of the cause of new-onset gastrointestinal bleeding.
Insights
Mallory-Weiss Syndrome (MWS) is a cause of upper gastrointestinal bleeding. This case suggests prolonged swimming and air travel may contribute to MWS development, highlighting new potential risk factors.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Mallory-Weiss Syndrome (MWS) typically results from forceful vomiting, often linked to alcohol abuse.
- Other reported associations include pregnancy, migraines, hiatal hernias, gastric ulcers, biliary disease, and certain medications.
Observation:
- A 32-year-old male presented with MWS and gastrointestinal bleeding after extensive swimming followed by a commercial flight.
- This case explores unusual triggers for MWS, diverging from common causes.
Findings:
- The study discusses the physiological effects of prolonged swimming, such as increased central blood volume.
- It also considers the impact of reduced atmospheric pressure during commercial air travel.
- The combination of these environmental and physiological factors is proposed as the cause of MWS in this patient.
Implications:
- Air travel and strenuous athletic activities should be considered potential contributing factors in diagnosing new-onset gastrointestinal bleeding.
- This broadens the differential diagnosis for MWS beyond typical triggers.