Spontaneous intramural oesophageal perforation.

Two cases of spontaneous intramural perforation of the oesophagus are described. In both, the area of dissection was extensive. The former recovered without operation; the latter required right thoracotomy and mediastinal and bilateral pleural drainage. Functionally, both have subjectively normal swallowing, but with fluoroscopic and manometric depression of peristalsis. In the light of this recent clinical experience the classification of oesophageal perforation is redefined. The differences between spontaneous and perforation of the oesophagus are stressed, as well as the importance of recognizing this new form of oesophageal perforation as a further lesion in the differential diagnosis of sudden, severe, retrosternal pain.