The spectrum of spontaneous and iatrogenic esophageal injury: perforations, Mallory-Weiss tears, and hematomas

J Clin Gastroenterol. 1999 Dec;29(4):306-17. doi: 10.1097/00004836-199912000-00003.


Esophageal perforations, Mallory-Weiss tears, and esophageal hematoma involve traumatic injury to the esophagus. These can be iatrogenic, in particular due to esophageal instrumentation, but can also occur spontaneously. The remarkable increase in diagnostic and therapeutic endoscopy as well as esophageal surgery has made instrumentation the most common cause of esophageal perforation. In many instances, spontaneous perforations are associated with retching and vomiting, which causes a sudden increase in intraesophageal pressure. A high index of suspicion leading to rapid diagnosis and appropriate therapy are needed to optimize clinical outcomes. This article focuses on esophageal perforations, Mallory-Weiss tears, and esophageal hematomas, with emphasis on etiology, pathogenesis, clinical presentation, diagnosis, management, and prevention.

Publication types

  • Review

MeSH terms

  • Esophageal Diseases / diagnosis
  • Esophageal Diseases / etiology*
  • Esophageal Perforation* / diagnosis
  • Esophageal Perforation* / etiology
  • Esophageal Perforation* / prevention & control
  • Esophageal Perforation* / therapy
  • Esophagus / injuries*
  • Hematoma / diagnosis
  • Hematoma / etiology
  • Humans
  • Iatrogenic Disease*
  • Mallory-Weiss Syndrome / etiology
  • Mallory-Weiss Syndrome / therapy
  • Rupture, Spontaneous
  • Surgical Instruments / adverse effects