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July 14, 1978

Nonsurgical Management of Spontaneous Esophageal Perforation

JAMA. 1978;240(2):140-142. doi:10.1001/jama.1978.03290020062026

HERMANN Boerhaave, DPhil, DMed, published the first case report of spontaneous esophageal rupture in 1724 after establishing the diagnosis at the autopsy of Baron von Wassenaer, Grand Admiral of the Dutch Fleet. Although Jacob Meyer reported the first antemortem diagnosis of this entity in 1858, the first successful surgical repair was not until 1947.1 Without esophageal repair, the mortality is reported to be from 75% to 90%.2-4 Without any form of surgical therapy, eg, chest drainage, the mortality approaches 100%, as recently reported by Campbell and co-workers5 in The Journal. A survivor of this disease was cured using closed pleural drainage, antibiotics, intravenous hyperalimentation, and gastric and esophageal suction.

Report of a Case  A 55-year-old man was admitted to the hospital for evaluation of chest pain. His medical records showed a history of duodenal ulcer and a sliding hiatal hernia, without reflux. His only major surgery was