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This term refers to the perforation of all layers of the oesophagus and the leakage of air and ingesta into the surrounding tissues.  The contents of the oesophagus are not sterile and bacteria are seeded into surrounding tissues when the oesophagus is ruptured.  For most of its length, the oesophagus runs through the thoracic cavity within the mediastinum, meaning that ruptures in this location cause septic '''mediastinitis''' and '''pneumomediastinum'''.  The mediastinum is continuous with the fascial planes of the neck and the spread of air and bacteria into this region leads to '''subcutaneous emphysema''' and '''cellulitis'''.  It has been suggested that the spread of infection along fascial planes may be assisted by the motion of peristalsis or of pulsation in the carotid arteries.  If the parietal pleural membrane (which lines the mediastinum) is also ruptured, infection and air can enter the pleural space (between the parietal and visceral pleurae), causing '''pyothorax''' and '''pneumothorax'''.  If more air is drawn into the mediastinum or pleural cavity through the rupture during each inspiratory phase but not expelled during exhalation, a '''tension pneumothorax''' may develop, in which the contents of the thorax are gradually compressed by the accumulation of air.  If infectious agents spread into the blood, there is a risk of systemic sepsis.  Finally, if the perforation is caused by a sharp object in the region of the heart base, the great vessels arising from the heart may be lacerated causing '''fatal internal haemorrhage'''.

This term refers to the perforation of all layers of the oesophagus and the leakage of air and ingesta into the surrounding tissues.  The contents of the oesophagus are not sterile and bacteria are seeded into surrounding tissues when the oesophagus is ruptured.  For most of its length, the oesophagus runs through the thoracic cavity within the mediastinum, meaning that ruptures in this location cause septic '''mediastinitis''' and '''pneumomediastinum'''.  The mediastinum is continuous with the fascial planes of the neck and the spread of air and bacteria into this region leads to '''subcutaneous emphysema''' and '''cellulitis'''.  It has been suggested that the spread of infection along fascial planes may be assisted by the motion of peristalsis or of pulsation in the carotid arteries.  If the parietal pleural membrane (which lines the mediastinum) is also ruptured, infection and air can enter the pleural space (between the parietal and visceral pleurae), causing '''pyothorax''' and '''pneumothorax'''.  If more air is drawn into the mediastinum or pleural cavity through the rupture during each inspiratory phase but not expelled during exhalation, a '''tension pneumothorax''' may develop, in which the contents of the thorax are gradually compressed by the accumulation of air.  If infectious agents spread into the blood, there is a risk of systemic sepsis.  Finally, if the perforation is caused by a sharp object in the region of the heart base, the great vessels arising from the heart may be lacerated causing '''fatal internal haemorrhage'''.

Perforation may occur when sharp [[Oesophageal Foreign Body|foreign bodies]] become lodged in the oesophagus or when attempts are made to remove these objects endoscopically or surgically.  Ruptures may also occur when anastomotic sites dehisce after oesophagectomy (as performed for the treatment of [[Oesophageal neoplasia|oesophageal neoplasia]].  

Perforation may occur when sharp [[Oesophageal Foreign Body|foreign bodies]] become lodged in the oesophagus or when attempts are made to remove these objects endoscopically or surgically.  Ruptures may also occur when anastomotic sites dehisce after oesophagectomy (as performed for the treatment of [[Oesophageal Neoplasia|oesophageal neoplasia]].)

==Diagnosis==

==Diagnosis==