Treatment options of esophageal perforation/ leaksEsophageal leaks and perforations span a spectrum of severity. Whether benign or malignant, leaks and perforations are caused by a transmural disruption of the esophagus (1). Most esophageal perforations are iatrogenic and occur during diagnostic and endoscopic procedures (2). Boerhaave syndrome represents a perforation caused by an abrupt increase in the esophageal pressure following emesis in the absence of relaxation of the superior esophageal sphincter (3-5). It was first described by the Dutch physician Herman Boerhaave. Boerhaave presented the autopsy findings of Baron von Wassenaer, Grand Admiral of the Fleet of Holland (6,7). von Wassenaer presented to Boerhaave after a night of overeating, several episodes of emesis, and chest pain. In Boerhaave's report, he described classic features noted in esophageal perforations including mediastinal emphysema and contamination of the pleural fluid (6,7).Leaks and perforations can be diagnosed by chest X-ray (CXR). However, the gold standard study remains contrast esophagram using a water-soluble medium that may have to be followed by a barium study if the initial result is negative.If there is an issue with performing an esophagram, the alternative is a contrast-enhanced computed tomography (CT) scan (8,9). Signs of perforation and leaks include mediastinal air, extravasated luminal contrast, periesophageal fluid collections, and pleural effusions (8,9). An endoscopic procedure is also recommended for confirmatory diagnosis as well as diagnostic decision making (8,9). The treatment options for esophageal leaks and perforations are associated with considerable morbidity and mortality (10). Based on work dating back to 1936, Jemerin was the first to confirm that drainage surgery should be the standard for leaks and perforations. Studies before this time showed that no surgical treatment would lead to significant death in twenty-four hours (11). Most of these drainage procedures occurred in the neck, and perforations were due to iatrogenic causes. Collis, in 1944, was the first to perform a thoracotomy for rupture (12,13). Barrett, Olsen, and Clagett presented other studies to confirm the importance
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