Boerhaave's syndrome: diagnosis and surgical management.

Spontaneous oesophageal perforation, or Boerhaave's syndrome, represents barogenic oesophageal injury. Patients don't always present with classical features and treatment may be delayed. Various approaches and strategies have been described but, despite advances in surgery and critical care, the condition continues to carry a high morbidity and mortality. Primary repair may be undertaken in patients who present within 24 hours of perforation and remains the gold standard. Increasingly, this strategy is being adopted for patients who present later with similar mortality rates. Diversion with exclusion and resectional procedures may be undertaken when repair is not possible.