Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2019; 7(24): 4407-4413
Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4407
Treatment of severe upper gastrointestinal bleeding caused by Mallory-Weiss syndrome after primary coronary intervention for acute inferior wall myocardial infarction: A case report
Bei-Bei Du, Xing-Tong Wang, Xiang-Dong Li, Pei-Pei Li, Wei-Wei Chen, Si-Ming Li, Ping Yang
Bei-Bei Du, Xiang-Dong Li, Pei-Pei Li, Wei-Wei Chen, Si-Ming Li, Ping Yang, Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun 130031, Jilin Province, China
Xing-Tong Wang, Department of Hematology and Oncology, Cancer Center, The First Hospital of Jilin University, Changchun 130031, Jilin Province, China
Author contributions: Du BB and Li PP were the patient’s physicians; Du BB and Chen WW performed the coronary angiography; Li XD and Li SM helped with the endoscopy diagnosis and treatment; Li PP helped with acquisition of data; Du BB, Wang XT, and Li SM reviewed the literature and contributed to manuscript drafting; Du BB, Wang XT, and Yang P were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by National Natural Science Foundation of China, No. 81570360; Beijing Lisheng Cardiovascular Grant, No. LHJJ201612425.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ping Yang, MD, PhD, Chief Doctor, Director, Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, No. 126, Xiantai Street, Changchun 130031, Jilin Province, China. pyang@jlu.edu.cn
Telephone: +86-431-84995091 Fax: +86-431-84995091
Received: September 14, 2019
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Acute upper gastrointestinal bleeding, Mallory-Weiss syndrome, Primary coronary intervention, Acute myocardial infarction, Endoscopic treatment, Case report

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.