Mallory-Weiss Syndrome with Colonic Lavage -A Case Report-

Yukihiro Nishida, Masayasu Hamaji, Hiromasa Sakaguchi, Satoru Miyazaki, Akio Kuhara, Masatoshi Ishida and Takashi Ito

Department of Surgery, Higashi-Osaka City General Hospital

We present a case of Mallory-Weiss syndrome (MWS), induced by rapid colonic preparation, and review the previous literature. A 58-year-old female developed nausea and hematemesis immediately after ingestion of 1.8 liters of colonic lavage solution over a period of about 30 min. Endoscopy revealed active bleeding distal to the esophago-gastric junction, however, endopscopic hemostasis was unsuccessful. Since melena was followed, laparotomy was attempted. Since hard induration was palpated in the cardia of the stomach, proximal gastrectomy was performed. Histologically, the muscular layer was completely distrupted and yet absent of malignancy. Preservation of the stomach was considered to be possible by transgastric hemostasis. Rapid colonic lavage-induced MWS has been reported in 8 cases in Japanese literature and in 7 cases elsewhere in other countries. We should be aware of this uncommon complication associated with colonic preparation. Physicins should be informed that a large volume of lavage solution should be given at a rate slower than 1 liter/hr, and advised that adnministration should be discontinued if repeated emesis develops, and that the patient should be placed under medical observation.

Key words
colonic lavage, Mallory-Weiss syndrome, Boerhaave syndrome

Reprint requests
Yukihiro Nishida Department of Surgery, Higashi-Osaka City General Hospital 3-4-5 Nishiiwata, Higashi-Osaka, 578-8588 JAPAN

Accepted
December 9, 1998

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