Life-Threatening Mallory-Weiss Tears: From Upper Gastrointestinal Bleed to Multisystem Crisis - A Case Report

Document Type : Case Report

Authors

1 Department of Internal Medicine, University of Arkansas for Medical Sciences Northwest Regional Campus, Fayetteville, Arkansas, USA

2 College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, Arkansas, USA

3 Health Orlando Incorporated, Orlando, Florida, USA

4 Department of Internal Medicine, Mercy Hospital Northwest Arkansas, Rogers, Arkansas, USA

10.30476/acrr.2026.109805.1278

Abstract

Introduction: Hypoxic respiratory failure, defined as arterial oxygen tension (PaO₂) <60 mmHg on room air,
is commonly caused by pulmonary conditions such as pneumonia, pulmonary embolism, or acute respiratory
distress syndrome. Less frequently, systemic factors such as hemorrhagic shock can impair oxygen delivery
due to severe anemia and reduced perfusion. Mallory-Weiss tears (MWTs) are longitudinal mucosal lacerations
at the gastroesophageal junction, typically caused by vomiting or retching, and may result in significant upper
gastrointestinal (GI) bleeding.
Case Description: We report a case of an 81-year-old woman with gastroesophageal reflux disease and a prior
cerebral infarct for which she was taking apixaban. She presented with stroke-like symptoms and became
hypoxic en route to the hospital, requiring intubation. Laboratory evaluation revealed profound anemia
(hemoglobin 2.8 g/dL), metabolic acidosis (pH 6.95, bicarbonate 8 mmol/L), and elevated lactic acid (8.1 mg/
dL). She received multiple blood products, reversal of anticoagulation, and supportive care in the intensive care
unit. Initial imaging showed a hiatal hernia but no active bleeding. Nasogastric output demonstrated coffeeground material. Esophagogastroduodenoscopy on day 2 revealed an MWT. She was extubated on day 3 and
discharged on day 11.
Discussion: This case emphasizes the importance of considering non-pulmonary causes of hypoxia, particularly
severe anemia from occult GI bleeding, even in the absence of overt signs. Hypoxia was primarily driven
by reduced oxygen-carrying capacity rather than intrinsic lung pathology. Timely recognition, endoscopic
diagnosis, hemostasis, and restoration of hemoglobin reversed respiratory compromise. Clinicians should
maintain a high index of suspicion for occult bleeding in unexplained hypoxic respiratory failure.

Highlights

Sahil Sabharwal (Google Scholar)

Keywords


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