Mallory-Weiss Tear Due to Barotrauma in a Scuba Diver

Abstract

Purpose: Gastric barotrauma has been reported in scuba divers, but so far there has been only one case reported of a Mallory Weiss tear due to barotrauma induced by shallow water scuba diving. Methods: In this case report we present a 29 year old male who presented with two episodes of hematemesis. He is a professional diver who does underwater construction work. His job requires multiple ascents and descents in shallow waters. The patient had worked the day prior to his presentation. During that day he experienced vague abdominal discomfort which progressed to pain in a few hours. The day of admission his pain had improved but he developed nausea followed by 2 episodes of vomiting approximately 15 minutes later. He denied retching prior to this episode. Both episodes involved bright red blood with emesis. The amount was described as large. He was seen and evaluated in the ER. Physical examination was significant for sinus tachycardia at 110 beats per minute. Initial hemoglobin was 8.8 with prior baseline being 13.4. After initial fluid resuscitation an upper endoscopy was performed and revealed a 2 cm linear tear at the GE junction. No active bleeding was noted at the site. No other potential source of bleeding was identified. Results: Mallory Weiss tear can be induced due to rapid expansion of compressed air in the stomach during ascent after diving. Expansion of air in the stomach with the decrease in the surrounding pressure, during the ascent can cause significant force towards the gastric wall. Conclusion: Overpressure barotrauma can induce a Mallory Weiss tear.