Atraumatic perforation of the esophagus: current concepts and report of an additional case

Truly atraumatic perforation of the esophagus is extremely rare. One such case with clinical features classic of this entity is reported. Characteristic findings of hydropneumothorax and pneumomediastinum on plain chest film, and the contrast esophagogram confirmed the diagnosis quickly. However, since the patient sought medical help late, with established septicemic shock, only closed chest drainage could be offered which proved grossly inadequate, and the patient died within 24 hours of presentation. As in the literature, this case report suggests that a case of esophageal perforation can easily and quickly be recognized on plain chest film, and that early aggressive surgical intervention in the form of open and wide mediastinal and chest drainage, with or without esophageal repair, resection or exclusion, offers the patients the best chances of survival against this otherwise invariably fatal event.