SPONTANEOUS rupture of the esophagus is an uncommon occurrence. Considerable data concerning the classic picture of this condition have been collected in the recent literature,1 yet, as in our case, the diagnosis is missed in about 80% of the reported cases.
Rupture should be distinguished from perforation, although both conditions invoke the same syndrome. Perforation is caused by trauma, such as instrumentation or foreign bodies, and by ulcers or tumors, which ulcerate or erode the esophageal wall. Spontaneous rupture occurs in an apparently normal esophagus after prolonged forceful vomiting, drinking bouts, straining at stool, lifting of a heavy weight, convulsive seizure, parturition, or without any known cause.
The mechanism of this condition is not exactly known. Macklerla believes that it is caused by increased intraesophageal pressure transmitted from the stomach. In 65 fresh human cadavers he inflated and ruptured the esophagus. The rupture always occurred in the left