Times and trends in the treatment of spontaneous perforation of the esophagus: from Herman Boerhaave to the present age.

Spontaneous rupture of the esophagus is a rare devastating condition, which was first described by Herman Boerhaave in 1724. Only a handful of cases were recorded during the 18th and 19th centuries. Diagnosis was usually obtained on autopsy. Only in 1914 Irving Walker achieved the first antemortem diagnosis of spontaneous rupture of the esophagus. The dawn of thoracic surgery during the first decades of the 20th century opened up the way for operative cure. More than 200 years after Boerhaave's initial report, Barrett as well as Clagett and Olsen independently accomplished the first successful surgical treatment by primary repair of the esophageal lesion in 1947. Since those pioneer days, various suggestions for proper treatment have been made ranging from conservative, nonoperative means to extended procedures such as esophagectomy. Invention of minimally invasive surgery and endoscopic measures has further broadened the spectrum of available therapeutic options. The aim of this history article is to outline the development of diagnosis and management of spontaneous rupture of the esophagus from the age of Herman Boerhaave to the present times.