The diagnosis and management of esophageal perforations

Despite the widespread availability of flexible fiberoptic upper gastrointestinal endoscopes, perforation of the esophagus continues to pose a formidable diagnostic and therapeutic problem for the clinician. Failure to recognize and treat a contained mediastinal perforation can result in death in a matter of hours. The most common etiology is still iatrogenic; therefore, attention to detail and proper training for endoscopists is paramount in reducing the morbidity and mortality associated with this disorder. This article reviews the diagnosis and treatment of esophageal perforation and discusses measures to avoid this potentially lethal complication.