Barogenic perforation of the esophagus distal to a stricture after endoscopy

Instrumentation is the most common cause of esophageal perforation, usually at or above a stricture. We report an unusual case in which the perforation occurred distal to a proximal esophageal stricture during diagnostic endoscopy. The perforation occurred close to the gastroesophageal junction involving an apparently normal esophagus, in a manner similar to that of "spontaneous," barogenic esophageal rupture (Boerhaave's syndrome). We postulate that the abrupt rise in pressure in the intraluminal esophagus, the inlet of which was obstructed by a tightly fitting instrument, was responsible for the rupture.