Upper gastrointestinal bleeding in a quadriplegic patient.

This paper presents an unusual case of gastrointestinal (GI) bleeding which followed a period of nausea and vomiting in a quadriplegic patient in whom endoscopy revealed a tear in the distal esophagus. Similar lesions have been described as the Mallory-Weiss syndrome. The physiology of vomiting is presented, wherein abdominal muscle contraction plays a partial role. The pathophysiology in the patient who lacks functional abdominal muscles is considered in relation to etiology. It is suggested that mucosal tears similar to those associated with a Mallory-Weiss syndrome be added to the differential diagnosis of upper GI bleeding in quadriplegic patients.