ABSTRACT
Esophageal perforation has been and remains a significant diagnostic and clinical management dilemma. Unless temporally related to esophageal instrumentation, perforation of the thoracic esophagus may be easily confused with myocardial infarction, aortic dissection, pancreatitis, or other chest or abdominal emergencies. Historically, key decisions regarding the management of esophageal perforation relied upon several anatomic, physiologic, and temporal findings. Ben-David's group in Florida has an algorithm in place for the management of esophageal perforations. In 2013, Gubler published a landmark paper presenting the largest single series of patients with benign esophageal perforations that were treated with stents where there is long-term follow-up data. There is no standardized treatment for esophageal perforations caused by benign processes and thus the debate rages on as to whether surgical or nonsurgical management is preferable. The pendulum of treatment has swung from early aggressive operative management to early aggressive conservative management.
