Best chance for survival is rapid diagnosis and therapy. Delay in diagnosis is common, resulting in substantial morbidity and mortality. This chapter will discuss the causes, investigation, and initial therapy for this potentially lethal gastrointestinal perforation. Two distinct entities, esophageal rupture and esophageal perforation, will be described. Thus, the wall is weaker and may rupture at a lower intraluminal pressure.
Vomiting usually precedes development of spontaneous perforation.
Tears usually are from 0.6-8.9 cm in length. Predilection for left-side perforations may be due to lack of adjacent supporting structures, thinning of musculature in lower esophagus, and anterior angulation of esophagus at left diaphragmatic crus. Tears normally extend superiorly. Perforation of esophagus, as a result of instrumentation or trauma, seems not to have a specific site predilection. Of these 17, tumors were found in 8 and achalasia in 4.