Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4407
Peer-review started: September 14, 2019
First decision: October 24, 2019
Revised: November 3, 2019
Accepted: November 15, 2019
Article in press: November 15, 2019
Published online: December 26, 2019
Processing time: 101 Days and 15.5 Hours
Upper gastrointestinal bleeding (UGIB) after an acute myocardial infarction (AMI) is not an uncommon complication. Acute UGIB caused by Mallory-Weiss syndrome (MWS) is usually a dire situation with massive bleeding and hemodynamic instability. Acute UGIB caused by MWS after an AMI has not been previously reported.
A 57-year-old man with acute inferior wall ST elevation myocardial infarction underwent a primary coronary intervention of the acutely occluded right coronary artery. Six hours after the intervention, the patient had a severe UGIB, followed by vomiting. His hemoglobin level dropped from 15.3 g/dL to 9.7 g/dL. In addition to blood transfusion and a gastric acid inhibition treatment, early endoscopy was employed and MWS was diagnosed. Bleeding was stopped by endoscopic placement of titanium clips.
Bleeding complications after stent implantation can pose a dilemma. MWS is a rare but severe cause of acute UGIB after an AMI that requires an early endoscopic diagnosis and a hemoclip intervention to stop bleeding.
Core tip: Upper gastrointestinal bleeding (UGIB) after an acute myocardial infarction (AMI) is not an uncommon complication. Acute UGIB caused by Mallory-Weiss syndrome (MWS) after an AMI has not been previously reported. Here we report the diagnosis and management of a 57-year-old AMI patient who developed UGIB caused by MWS shortly after the primary coronary intervention. In addition to blood transfusion and acid inhibition treatment, early endoscopy was employed, and MWS was diagnosed. Bleeding was stopped by endoscopic hemoclip intervention with close monitoring of the hemodynamic status.