The literature records innumerable instances of perforation of the esophagus by foreign bodies either because of the nature of the foreign body or by accident during the use of the esophagoscope. Perforation by caustics has occurred frequently. Aneurysm and neoplasm, as well, have been prominent etiologic factors in esophageal perforation in adults. However, rupture of the esophagus from external trauma has been unusually rare. A search through the Cumulative Index failed to reveal a record of a case in which the esophagus was ruptured from a blow on the surface of the body. The findings of such a case prompted us to make the following report: Report of Case.—J. E., male, four and one-half years of age, was admitted to the Highland Park Hospital, Oct. 28, 1936, by W. E. Richberg, M.D., suffering from shock, pallor, severe pain, and board-like rigidity of the abdomen following an injury. A few hours previously, the child had climbed upon a stone mantelpiece which, becoming dislodged, had caused him to fall to the floor in such a way that the heavy mantelpiece landed across the upper portion of his abdomen. At the time of admission the pulse was 130, the temperature 104 degrees. An x-ray examination of the chest made eight hours following the accident showed a pneumothorax on the right side with a partially collapsed lung (Fig. 1). The possibility that this had been caused by a fractured rib was considered, but no fracture could be located. A thoracentesis was done and air was withdrawn. Because of the marked abdominal tenderness and rigidity, it was thought that an injury to the intestinal tract, possibly a perforation, had occurred. A laparotomy was performed by Gatewood but no demonstrable lesion was found. The stomach, small intestine, and colon appeared normal, but a small amount of blood was seen the intestinal wall, within the lumen of the intestine. The patient stood the operation satisfactorily but his general condition remained poor. At this time the patient was seen by one of us (C. A. A.) in consultation. The following day the physical findings in the right half of the thorax changed. Instead of tympany there was marked dullness. A chest roentgenogram (Fig. 2) showed the right lung-field blotted out, apparently by fluid. A thoracentesis now revealed that the pleural cavity contained gastric contents. A diagnosis of ruptured esophagus was made. The child's temperature rose to 108 degrees without showing any relief of earlier symptoms, and death occurred within 48 hours from the time of the accident. At necropsy the viscera showed no marked change except that two large holes were found in the lower third of the esophagus above the diaphragm. This allowed free communication between the lumen of the esophagus and the right pleural cavity.