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Oesophageal lacerations: Mallory–Weiss tear and Boerhaave rupture

  • Lesion

Violent retching can split the lining near the stomach (and bleed) or, rarely, burst the whole wall of the oesophagus.

Updated

What it is

A sudden rise in pressure inside the oesophagus, usually during forceful vomiting, can tear its wall near the gastro-oesophageal junction. Normally the junction relaxes reflexly before vomiting; when this fails during prolonged retching, the distended wall splits. In a Mallory–Weiss tear only the mucosa and submucosa give way; in Boerhaave syndrome the tear is transmural and the oesophagus perforates into the mediastinum.

Structure

  • Mallory–Weiss: one or more linear tears, usually a few centimetres long, crossing the junction; mucosa and submucosa only.
  • Healing tear: granulation tissue with acute inflammation at the edges.
  • Boerhaave: a full-thickness split, usually in the left posterolateral distal oesophagus, with mediastinal inflammation.

Step by step

  1. Prolonged retching raises intra-abdominal and intra-oesophageal pressure.
  2. The gastro-oesophageal junction fails to relax ahead of the vomiting wave.
  3. The distended wall tears lengthwise.
  4. Mucosal tear: bleeding into the lumen. Transmural tear: gastric contents spill into the mediastinum.

Clinical notes

  • Haematemesis after a bout of vomiting points to a Mallory–Weiss tear.
  • Chest pain, surgical emphysema in the neck and shock after vomiting point to Boerhaave rupture.

Test yourself

Think of the answer, then tap the question to see it.

Which wall layers tear in a Mallory–Weiss lesion?

The mucosa and submucosa only, in longitudinal tears across the gastro-oesophageal junction.

What distinguishes Boerhaave syndrome from a Mallory–Weiss tear?

The tear is transmural, so the oesophagus perforates and gastric contents enter the mediastinum.

What is the usual setting for a Mallory–Weiss tear?

Severe retching or vomiting, classically during acute alcohol intoxication.

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: Upper Gastrointestinal Bleeding (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.