Thirty-two consecutive unselected patients with traumatic esophageal perforation treated in the past seven years were reviewed. Perforation was due to gunshot wounds, stab wounds, instrumentation, or massive lye ingestion. Of the 12 patients seen in the first four years (Group I) who were treated with primary closure or tube thoracostomy, intravenous fluids, and antibiotics, 5 died. In a second group of 15 patients seen in the last three years (Group II) who received 2,000 to 3,000 calories daily either intravenously or by tube feeding, only 1 patient died; 5 other patients with high, isolated injuries of the cervical esophagus who went home within one week were excluded from Group II. The time from perforation to definitive therapy was approximately the same in both groups, as was the severity and type of perforation. Complications were similar in each group and included abscess, empyema, mediastinitis, hemorrhage, fistula, and pneumonia. Three times the associated injuries per person occurred in Group II as in Group I. Therefore there appeared to be a greater potential for complications and death, but only 1 of the 15 patients died as compared with 5 of the 12 Group I patients. This limited mortality appeared to be due to the increased nutritional regimen.