Clinical Reviews: Esophageal And Gastric DiseasesThe Spectrum of Spontaneous and Iatrogenic Esophageal Injury Perforations, Mallory-Weiss Tears, and HematomasYounes, Ziad, M.D.; Johnson, David A., M.D.Author Information From the Department of Internal Medicine (Z.Y.), Gastroenterology Division, Johns Hopkins Bayview Medical Center, Baltimore, MD; and Eastern Virginia Medical School (D.A.J.), Norfolk, VA. Address correspondence and reprint requests to Dr. David A. Johnson, Digestive and Liver Disease Specialists, 844 Kempsville Road, Suite 106, Norfolk, VA 23502. Journal of Clinical Gastroenterology: December 1999 - Volume 29 - Issue 4 - p 306-317 Buy Abstract Esophageal perforations, Mallory-Weiss tears, and esophageal hematoma involve traumatic injury to the esophagus. These can be iatrogenic, in particular due to esophageal instrumentation, but can also occur spontaneously. The remarkable increase in diagnostic and therapeutic endoscopy as well as esophageal surgery has made instrumentation the most common cause of esophageal perforation. In many instances, spontaneous perforations are associated with retching and vomiting, which causes a sudden increase in intraesophageal pressure. A high index of suspicion leading to rapid diagnosis and appropriate therapy are needed to optimize clinical outcomes. This article focuses on esophageal perforations, Mallory-Weiss tears, and esophageal hematomas, with emphasis on etiology, pathogenesis, clinical presentation, diagnosis, management, and prevention. © 1999 Lippincott Williams & Wilkins, Inc.