Construed literally, the designation Mallory-Weiss syndrome refers to massive painless hematemesis from lacerations which traverse the gastroesophageal junction. The lacerations extend into the submucosa but do not rupture through the entire thickness of the wall. They usually follow forced vomiting but may occur after prolonged severe coughing bouts or a variety of other antecedents. Although it may be necessary to repair such lacerations surgically, there is time to treat patients for loss of blood and fluid and for shock. It is almost impossible to diagnose the Mallory type of laceration without esophagoscopy or surgical incision. A proportion of undiagnosed cases of hematemesis probably can be ascribed to such lacerations. With blood replacement, pressor agents, and supportive measures, the majority of patients recover from the acute episode. Though dangerous, Mallory-Weiss lacerations need not be accompanied by high mortality.
In contrast, rupture of the esophagus is a surgical emergency. Though the pathogenesis