Perforation of the esophagus can occur secondary to a number of disparate processes 23 as noted in Table.71-3. Iatrogenic injury is the most frequent cause of esophageal injury, accounting for up to 75 percent of all perforations. Endoscopy, a prime offender, has a lesser rate of perforation when performed on an esophagus free of disease than does endoscopy of a diseased esophagus. Dilation of strictures increases the risk of perforation greatly. Other intraluminal procedures, such as variceal therapy or Sengstaken-Blakemore tubes and palliative laser treatment for cancer, are also associated with perforation. A well-recognized clinical scenario of postemetic perforation, Boerhaave syndrome, is responsible for roughly 10 to 15 percent of esophageal perforations and is discussed below.
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