Spontaneous Perforation of the Normal Esophagus

1) Spontaneous perforation of the esophagus is a distinct clinical entity, in which, sudden rupture through all layers occurs in the lower end of a normal esophagus. 2) The diagnosis has been rarely made during life so treatment could be instituted. The mortality until very recently has been 100 per cent. 3) Rupture occurs usually in a middle aged, alcoholic male. 4) The laceration classically occurs in the lower one-fifth of the esophagus, in a longitudinal direction and on the left posterolateral aspect and is sharp edged and incised in appearance. Mediastinitis, empyema and pneumothorax usually result immediately. 5) Chest roentgenograms, thoracentesis and subcutaneous emphysema will enable one to make a correct diagnosis. 6) A case report of a patient unsuccessfully treated is presented. 7) On the basis of laboratory experiments a rationale of treatment is suggested involving supporting care with early thoracotomy and suture closure of the laceration.