Esophagus, Stomach, and Duodenum

This is a unique question-and-answer chapter for surgical residents and trainees, concentrating on the injuries of esophagus, stomach, and duodenum. The resultant sudden increase in intraluminal pressure creates a transmural esophageal tear, typically located in the left posterolateral aspect of the distal esophagus, 2-3cm above the gastroesophageal junction. The diagnostic test of choice is an esophagram. Mallory-Weiss tear is a common cause of upper gastrointestinal bleeding and typically presents as hematemesis after an initial episode of vomiting without blood. Many factors have been associated with the development of Mallory-Weiss tears, including alcohol use, use of aspirin and warfarin, paroxysms of coughing, pregnancy, heavy lifting, straining, seizures, blunt abdominal trauma, colonic lavage, and cardiopulmonary resuscitation. Endoscopic therapies that employ epinephrine injection, hemoclip placement, and band ligation have all been used with equal success to achieve primary hemostasis. Angiography with selective transcatheter embolization is another effective treatment option.