To the Editor.—Two cases of contained esophageal perforation, both of which were managed nonoperatively with good results, were reported in the Archives by Anderson and Giustra (1981;116:1214-1217). It seems that the term "perforation" is misleading, as the tear did not penetrate the entire esophageal wall. In their text, they explained that the perforation was confined within the lower esophageal wall and actually represented an intramural extravasation. I believe that this type of laceration is similar to the Mallory-Weiss lesion, but is deeper and extends into the submucosa. It seems doubtful that if the authors' emetogenic lacerations extended into or through the muscular layers, conservative management would have been successful.
I and my colleagues have seen several similar cases and considered the findings to represent a dissection of the esophageal wall in the submucosal layer, probably due to a combination of the emetogenic force and the subsequent hemorrhage contained within