Management of Spontaneous Esophageal Rupture

Abstract

To the Editor.— In addition to provoking less fanciful observations,The Journalarticle Nonsurgical Management of Spontaneous Esophageal Perforation (240:140, 1978) conjures up a vision of George Santayana strolling the Elysian fields with Hermann Boerhaave and consoling him because the lessons of history 1 are so often ignored. Although this is a defect of the human condition to which I too am prone, nevertheless the article raises substantive questions about patient care that warrant discussion. In the first place—a trap for those who have time only to scan titles— the crux of this patient's successful management was closed thoracotomy with tube drainage of the empyema, a procedure that hardly qualifies as nonsurgical. Furthermore, unexplained bilateral pleural effusion in a patient who vomited after a big meal and then had development of chest pain, dyspnea, and fever might reasonably suggest ruptured esophagus. The various laboratory studies done on both effusions would