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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 Nov 12, 2026

## Key points

- Mallory–Weiss: longitudinal mucosal tears across the gastro-oesophageal junction after retching, classically in heavy alcohol use; haematemesis.
- Most Mallory–Weiss tears stop bleeding and heal without surgery.
- Boerhaave: transmural rupture of the distal oesophagus; mediastinitis, chest pain, shock; a surgical emergency.
- Boerhaave can mimic myocardial infarction, perforated ulcer, pancreatitis, aortic dissection or pneumothorax.
- Both are on the list of oesophageal causes of haematemesis, with varices and erosive oesophagitis.

## 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

- Prolonged retching raises intra-abdominal and intra-oesophageal pressure.
- The gastro-oesophageal junction fails to relax ahead of the vomiting wave.
- The distended wall tears lengthwise.
- 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.

## Memory aid

Mallory marks the mucosa; Boerhaave bursts the barrel.

## 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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## Connections

## Related 4

- [Oesophageal varices: portosystemic collaterals and why they bleed](https://durgical.com/en/general-pathology/oesophageal-varices-portosystemic-collaterals-and-why-they-bleed/)
- [Acute gastritis and stress ulcers](https://durgical.com/en/general-pathology/acute-gastritis-and-stress-ulcers/)
- [Alcohol: how it injures the liver, brain, heart and fetus](https://durgical.com/en/general-pathology/alcohol-how-it-injures-the-liver-brain-heart-and-fetus/)
- [Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does](https://durgical.com/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/)

## Related conditions 3

- [Mallory-Weiss syndrome](https://durgical.com/en/conditions/mallory-weiss-syndrome/)
- [Oesophageal perforation (Boerhaave syndrome)](https://durgical.com/en/conditions/oesophageal-perforation/)
- [Upper gastrointestinal bleeding](https://durgical.com/en/conditions/upper-gastrointestinal-bleeding/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

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](https://www.ncbi.nlm.nih.gov/books/NBK470300/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/oesophageal-lacerations-mallory-weiss-tear-and-boerhaave-rupture/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/oesophageal-lacerations-mallory-weiss-tear-and-boerhaave-rupture/