Spontaneous intramural oesophageal perforation.

Spontaneous intramural oesophageal perforation appears at any level, but preferably on the posterior wall, and is usually longitudinal. Unlike the Mallory Weiss and the Boerhaave syndromes, females are more frequently affected. It appears with sudden retrosternal pain radiating to the epigastrium, neck and back, followed by haematemesis of small quantity and dysphagia. Vomiting is rare. In contrast to complete rupture, neither pneumomediastinum nor emphysema is observed, barium swallow being the diagnostic test of choice whenever this pathology is suspected. However, when the symptoms are not typical, endoscopy is a useful method for diagnosis. Treatment must be conservative, while surgery is suggested in the case of recurrent symptoms or big intramural haematomas with a high risk of perforation. A 74-year-old woman is presented. Endoscopy was performed as an emergency in suspected food impaction in the oesophagus. This case was diagnosed as spontaneous intramural oesophageal perforation. The patient also presented with oesophageal diverticulum and hiatal hernia. Conservative treatment was given, and the lesion cured.