Mallory-Weiss tear following cardiac surgery: transoesophageal echoprobe or nasogastric tube?

A case of fatal upper gastrointestinal bleeding from a Mallory-Weiss tear a fter transoesophageal echocardiography during cardiac surgery is reported. After the echocardiographic examination, which is considered a safe procedu re, a nasogastric tube was inserted which immediately revealed bright red b lood. Eventually the patient lost 9 litres of blood. The role of the echopr obe and the nasogastric tube in causing the Mallory-Weiss tear is discussed . Although this case is not conclusive about the mechanism of oesophageal d amage, it is suggested that the safety recommendations for transoesophageal echocardiography also apply for instrumentation of the oesophagus with a n asogastric tube after the transoesophageal echocardiographic examination.