Spontaneous rupture of the esophagus.

The records of all patients with spontaneous esophageal perforations who were examined between August 1966 and December 1978 were reviewed. Eleven patients (six men and five women) whose mean age was 62.8 years were treated during this period. Precipitating factors that contributed to perforation were identified in all patients. Ten patients had epigastric or low sternal pain. Chest roentgenograms were abnormal for all patients. Two patients were treated conservatively, and both died. Of the nine patients treated by thoracotomy, the two who were treated within 24 hours of perforation survived. Of the seven patients treated later than 24 hours, only three survived. Late treatment consisted of either primary closure or esophageal exclusion. Prompt surgical intervention remains the treatment of choice.