Boerhaave's syndrome and barogenic injuries of the esophagus.

Herman Boerhaave clearly elucidated the pathology of barogenic esophageal perforation during the 18th century by describing the sad and fatal case of Baron John von Wassenauer. Although the science of the time had no treatment and surgery was considered a fool's venture, Boerhaave's description has stood the test of time and set the stage for modern surgical repair and treatment. The expeditious diagnosis, aggressive early repair, and vigilant attention to drainage of esophageal perforations in the 20th century all reduce the morbidity and are essential steps to obtaining the best outcome. Today, survival of barogenic esophageal perforation requires the surgeon to have the clarity of Boerhaave's observation of symptoms and to make use of modern surgical techniques to assure the patient's recovery from Boerhaave's syndrome.