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British Journal of Anaesthesia, 2000, Vol. 84, No. 5 646-649
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Case Report

Mallory–Weiss tear following cardiac surgery: transoesophageal echoprobe or nasogastric tube?

A. J. De Vries1, J. M. A. A. van der Maaten1 and R. R. P. Laurens2

1 Department of Anaesthesiology, University Hospital Groningen, The Netherlands
2 Department of Cardiothoracic Surgery, University Hospital Groningen, The Netherlands

A. J. De Vries, Department of Anaesthesiology, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands

A case of fatal upper gastrointestinal bleeding from a Mallory–Weiss tear after transoesophageal echocardiography during cardiac surgery is reported. After the echocardiographic examination, which is considered a safe procedure, a nasogastric tube was inserted which immediately revealed bright red blood. Eventually the patient lost 9 litres of blood. The role of the echoprobe and the nasogastric tube in causing the Mallory–Weiss tear is discussed. Although this case is not conclusive about the mechanism of oesophageal damage, it is suggested that the safety recommendations for transoesophageal echocardiography also apply for instrumentation of the oesophagus with a nasogastric tube after the transoesophageal echocardiographic examination.


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