Mallory-Weiss syndrome: Possible link to water immersion and subsequent air flight

Mallory-Weiss Syndrome (MWS) lesions account for up to 15 per cent of upper gastrointestinal bleeding episodes. Typically these lesions present as a c onsequence of vomiting that is often associated with alcoholism. Recently o ther conditions such as pregnancy, migraine, hiatal hernia, gastric ulcer, biliary disease, and various medications have been associated with MWS. We report on a 32-year-old male who developed a MSW lesion after a prolonged p eriod of swimming followed by an extended commercial airplane flight. The h emodynamic changes associated with swimming (increased central distribution of blood volume) and the pressure changes in commercial aircraft (a reduct ion of 0.3 atmospheres of pressure) are discussed. We conclude that the com bination of these factors contributed to the development of a MWS lesion an d gastrointestinal bleeding in this patient. We recommend that both air tra vel and athletic activities be considered as possible contributing factors in the evaluation of the cause of new-onset gastrointestinal bleeding.