Spontaneous rupture of the esophagus, a complete tear of a previously normal organ, has been an uncommonly reported condition. As man indulges in the activities which predispose to it, however, the incidence may well increase in the future. Hermann Boerhaave (5) first recorded a case in 1724, but it was not until 1947 that Barrett (3) reported a case successfully treated by surgery. The more than 250 cases in the literature indicate an increased interest in establishing an early diagnosis, a prerequisite for successful surgical repair. It is necessary to distinguish between perforations and rupture of the esophagus. Perforations are always secondary to a disease process such as neoplasm, peptic esophagitis, ingestion of corrosive materials, or direct trauma as from instrumentation and biopsy procedures or from foreign bodies such as missiles. Ruptures occur abruptly in an apparently healthy esophagus, as a result of vomiting or other sudden increase in the intraluminal pressure. This pressure increase mig...