[Perforations on peptic ulcers of the esophagus]

The term "atraumatic perforation of the oesophagus" which is suggested by ABBOTT covers several entities. HEBERER and RIOULT draw a distinction between spontaneous ruptures, which have their seat in a macroscopically healthy zone of the oesophagus, and perforations, which are the final consequence of a constant, progressive process of parietal erosion. Such a perforation may be due to complications of the peptic disease of the oesophagus. The transition from the perforating or intramural ulcer to the disintegration of the entire wall, with the formation of a mediastinal abscess, is progressive. The seriousness of the affection results from the perforation of this abscess into a neighbouring organ or cavity (mediastinum, lung, pericardium, pleura). In most cases, however, the perforation is closed by reactional mediastinitis, which also limits the seriousness of the phenomenon and permits a comparatively mild form of treatment (drainage).--Out of six cases of atraumatic perforation, we have observed two perforations on peptic oesophagitis: one of them exceptional, perforated into the aorta with immediate death, and the other perforated into the mediastinum and cured after resection of the oesophagus.