Rupture of the esophagus is not a surgical oddity. It is a practical reality, occurring frequently enough to deserve serious consideration in determining the cause of sudden epigastric or low anterior thoracic pain. Otherwise, it will be mistaken for some other condition, with the result that direct repair of a torn and leaking esophagus will be postponed. The frequency of this error is illustrated by the fact that in one series of 50 cases of ruptured esophagus the abdomen was explored in 13 instances owing to a mistaken diagnosis of abdominal emergency. 1 Other reports of similar errors are on record. 2-4 More frequently, rupture of the esophagus has been confused with perforated peptic ulcer, myocardial infarction, pulmonary embolus, acute pancreatitis, spontaneous pneumothorax, dissecting aneurysm, perforated gallbladder, and mesenteric occlusion. 5 Although general attention has been directed toward direct surgical repair of this lesion for only 20 years, Marston and