Rupture of esophagus is a rare phenomenon causing leakage of esophageal contents into the mediastinum, with development of systemic inflammation and reactive pleural effusion. Esophageal rupture may be iatrogenic due to recent instrumentation, especially upper endoscopy, and with therapeutic procedures such as stent placement or stricture dilation. Spontaneous perforations, also known as Boerhaave syndrome, occur secondary to a sudden increase in intraluminal pressure combined with negative intrathoracic pressure. This may be due to vomiting or retching, although between 25%-45% of patients may not have such preceding history. Spontaneous ruptures are often found in the distal esophagus. The classic triad of symptoms for spontaneous esophageal rupture is known as Mackler triad and includes the sudden onset of chest pain and subcutaneous emphysema after recent vomiting or retching, often following dietary overindulgence.

Other common symptoms include pain over the anterior chest or abdomen, dysphagia, dyspnea, neck pain, back pain, or hematemesis. Physical exam may reveal tachycardia, tachypnea, fever, crepitus, upper abdominal rigidity, and shock. The mortality from esophageal rupture remains quite high, with mortality rates steadily increasing as the time to diagnosis from rupture increases.