Post-emetic laceration and rupture of the gastroesophageal junction

The experience of a major general hospital, over the last two decades, with the management of 50 patients presenting post-emetic lesions of the gastroesophageal junction is reviewed. The results of this study clarify the persistent confusion between the Mallory-Weiss syndrome and the Boerhaave's syndrome. The high incidences of upper gastro-intestinal mucosal lesions and hiatal hernia associated with the Mallory-Weiss syndrome, ignored in many previous studies, are emphasized in this report. Widespread utilization of fiberoptic endoscopy during the last 10 years has resulted in more accurate diagnosis of Mallory-Weiss lacerations, with more selective indications for surgical management of these cases of upper gastrointestinal bleeding. On the other hand, in the light of the results of this study, a strong plea is made in favor of early, aggressive surgical treatment for Boerhaave's syndrome. This entity remains one of the challenges of thoracic and abdominal surgery.