Treatment of Esophageal Perforations. Why, when and how?

Spontaneous rupture of the esophagus, the so-called Boerhaave’s syndrome, was first described in 1724 by Hermann Boerhaave as direct observation of Baron van Wassenaer, the Grand Admiral of the Dutch fleet. Nowadays, esophageal perforations are most commonly iatrogenic, caused during diagnostic and therapeutic endoscopic procedures.

Less common causes are spontaneous perforation, foreing body ingestion, trauma, operative injury and tumours. Independently of the etiology, esophageal perforation is a surgical emergency associated with significant morbidity and mortality.

Surgical therapy has been the dominant treatment but recent developments resulted in the expansion of treatment options to include nonoperative, endoscopic and hybrid approaches.