Dr Siddque Akbar Satti_thumb A 53 year old male with medical history of

 

  • An episode of Hematemesis a day ago.
  • Vomiting soon after taking meal since last one month
  • Dyspepsia or indigestion sine last 3 years.
  • Early satiety
  • Abdominal fullness
  • Epigastric discomfort

 

Presented to the Emergency Department of CDA hospital on 6th June 2015. Dr. Siddique Akbar Satti was on the case. Patient with such a long history of dyspepsia and an episode of hematemesis, without any history of any explainable risk factor such as, Portal hypertension, chronic hepatitis, esophageal varices, alcoholism, malena, Diabetes, was very unusual, and raise the suspicion that there is something wrong.

 

Dr. Siddique Akbar Satti, went for Upper GI endoscopy as he was of the view that the vomiting that follows soon after having meal, suggests that there is something wrong with the gastric outlet. So he did his endoscopy.

 

Following are the endoscopic views of the patient stomach.

 

Pyloric Stenosis, Endoscpic Picture, Courtesy Dr. Siddique Akbar Satti
 

Dr. Siddique Akbar Satti, writes in his report that gastric cavity is somewhat dilated with residual food in the stomach after 14 hours of fasting. Pylorus is somewhat deformed and stenosed and the endoscope was pushed in the duodenal bulb with some difficulty.

 

but there was no bleeding around the pylorus and the pt had the history of hematemesis, a day ago. Following picture explains the cause of hematemesis

 

Mallory Weiss Tear Endoscopic Picture By Dr. Siddique Akbar Satti

“This endoscopic picture shows the opening of the esophagus into the stomach. You can clearly see a laceration or tear in the wall of stomach near the opening. This tear or laceration is called Mallory Weiss Tear and that was responsible for the episode of hematemsis” Dr. Siddique Akbar Satti Explained Mallory Weiss Tear to his trainees.

Mallory Weiss tear is a laceration that is formed near the gastro-esophageal junction after forceful attempt of vomiting. It may result in hematemesis and sometimes may also need endoscopic intervention. Mallory Weiss tear is more common in alcoholics, and usually medical literature associates it with alcoholics. But here we have seen that Mallory Weiss tear was caused in a non-alcoholic, non smoker individual with pyloric stenosis. So we can say that any event that lead to forceful vomiting may cause Mallory Weiss Tear.

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