S4243 Massive Mid-Esophageal Mucosal Tear (10 cm) Managed Endoscopically With Hemoclips: A Case Report

Introduction: Mallory-Weiss tears are longitudinal mucosal lacerations typically located at the gastroesophageal junction, commonly measuring between 0.75 and 1.5 inches (approximately 2–4 cm) in length. These lesions often result from forceful retching or vomiting and are generally self-limiting, with most cases resolving spontaneously or requiring minimal intervention. However, extensive esophageal mucosal tears exceeding 10 cm are exceptionally rare and not well documented in medical literature. We present a case of a massive 10 cm mid-esophageal mucosal tear managed successfully with endoscopic clipping and intensive supportive care. Case Description/Methods: A 62-year-old woman with hypertension, diabetes mellitus, coronary artery disease, and gastroparesis presented with sudden-onset, intractable nausea and vomiting followed by more than 10 episodes of bright red hematemesis. She reported severe chest and epigastric pain following retching. Initial hemoglobin was 12.6 g/dL. Emergent esophagogastroduodenoscopy revealed a large, long, and deep mucosal tear in the mid-esophagus measuring approximately 10 cm with active oozing and bleeding. The tear was closed using 10 hemostatic clips (Boston Scientific) with successful hemostasis and no immediate complications. Clotted blood was found in the cardia, fundus, and body of the stomach; the duodenum was normal. Post-procedure, the patient was admitted to the intensive care unit, sedated, and intubated for airway protection. Computed tomography chest and abdomen showed no pneumomediastinum or perforation. She remained NPO for 1 week per gastroenterology recommendation. A PICC line was placed and total parenteral nutrition initiated. She remained hemodynamically stable with no signs of rebleeding, was successfully extubated the next day, and was later downgraded to the medical floor in improving condition. Discussion: This case highlights a rare, large esophageal mucosal tear treated entirely via endoscopic means. While most Mallory-Weiss tears are <3 cm and located at the gastroesophageal junction, this case involved a 10 cm tear in the mid-esophagus. Timely esophagogastroduodenoscopy and placement of 10 hemostatic clips allowed for complete closure and control of hemorrhage. ICU-level supportive care, including temporary mechanical ventilation, NPO status, and nutritional support with total parenteral nutrition, contributed to a favorable outcome. This case illustrates that even extensive esophageal mucosal injuries can be successfully managed without surgical intervention.