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In Reply.—Our article described a spectrum of perforations, case 1 being an intramural extravasation and case 2 a full-thickness injury or free perforation. The second case should answer Dr Thompson's statement, "It seems doubtful that if the authors' emetogenic lacerations extended into or through the muscular layers, that conservative management would have been successful." He further stated that it seemed unlikely that a fullthickness injury or a perforation was best managed conservatively, the latter type of injury invariably requiring operative treatment when recognized early. Our second case unequivocally demonstrates that such an injury can be managed conservatively and that an operation is not invariably needed. Dr Thompson described one case of intramural extravasation on which he operated. Although initially we also entertained the possibility of an operation in case 1, we succeeded in treating this problem conservatively without ill effect. In our article, we were careful to point out
ANDERSON OS, GIUSTRA PE. Esophageal Perforation-Reply. Arch Surg. 1982;117(7):982. doi:10.1001/archsurg.1982.01380310088025