Saul Allen Mackler (1913-2007)

Saul Allen Mackler (1913-2007) was an American thoracic Surgeon.

Mackler was an Associate Professor of thoracic surgery at Chicago Medical School. He is noted for numerous advancements to the field of thoracic surgery through his work at Michael Reese Hospital and Cook County Hospital, including contributions to the development of the cardiac pacemaker and surgical procedures correcting birth defects in pediatric cardiology

Eponymously remebered for Mackler’s Triad. In 1952 he described his clinical triad of vomiting, thoracic pain and subcutaneous cervical emphysema – as classic signs for oesophageal rupture, unfortunately only present 14-25% of the time.

  • Born December 9, 1913 in Brooklyn, New York
  • 1943-1946 Major in the US Army; North Africa, Sicily and Northern Italy
  • Cardiothoracic surgeon at at Michael Reese Hospital and Cook County Hospital
  • Associate Professor of thoracic surgery at Chicago Medical School
  • Died on December 1, 2007 in Illinois

Medical Eponyms
Mackler’s triad (1952)

Mackler described the three characteristic features of oesophageal rupture as vomiting, lower thoracic pain (T10) and subcutaneous cervical emphysema. Diagnostic of oesophageal rupture and an indication for left thoracotomy.

Mackler pointed out the difference between rupture and perforation. Rupture is a spontaneous cause or due to indirect trauma likely related to increase intra-abdominal pressure. Mackler supported this with the histopathology of oesophageal ruptures.

Mackler Fig 7 oesophageal rupture 1952
Fig 7. Photomicrograph of biopsy of the mucous membrane taken from the margin of the rupture which occurred in Case 1 (A) and Case 3 (B). There is no visible necrosis of tissue and no evidence of pre-existing ulceration. The presence of capillary dilatation and of small haemorrhagic areas in the submucosal layer indicates only acute reaction which is compatible with the trauma of rupture (x50). Mackler, 1952

Mackler identified the as the weakest part of the oesophageal wall in a cadaveric study. He found that a longitudinal tear in the lower extremity of the oesophagus was uniformly involved. In comparison with perforation in which oval tear if often formed.

Mackler's triad (1952) oesophageal perforation
Artist drawing from the original paper, showing a longitudinal tear in the lateral oesophagus. Mackler, 1952

Major Publications



Eponymous terms



the person behind the name

Graduated Medicine in 2020 from Queens University Belfast. Interested in Internal Medicine.

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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