PERFORATION of the esophagus from instrumentation is a tragic accident and an urgent surgical emergency. Unless promptly and properly treated, it is usually fatal. Proper treatment consists of the immediate establishment of wide and free drainage to the site of perforation in addition to adequate antibiotic and supportive therapy and other less important measures. This has been emphasized by Hoover,1 Touroff2 and others.
Although this discussion is concerned with perforation caused by instrumentation, it would seem desirable to include a classification of all causes.
A. Instrinsic causes
1. Tumors arising in the oesophagus
2. Esophagitis Nonspecific, tuberculous, syphilitic
3. Spontaneous perforations Ruptures from violent vomiting
4. Ulceration Peptic, Curling's (Rankin)3
B. Extrinsic causes
1. Instrumentation Endoscopy, dilation
2. Swallowed foreign bodies Bones, dentures, pins
3. Penetrating wounds Stab, bullet
4. Penetration of extrinsic neoplasms
5. Perforations of extrinsic infections Pyogenic and tuberculous adenitis and mediastinal abscesses