Esophageal perforation is a serious condition that if left untreated is usually fatal. The most common cause is related to esophageal instrumentation. Other causes include forceful vomiting, and obstructing esophageal tumors. The consequence of an esophageal perforation is the extravasation of oral secretions with bacteria into the mediastinal space leading to a severe inflammatory reaction, septic shock and then death. The most important factor in survival is the time from perforation to treatment - the sooner it is treated the better. Treatment includes intravenous antibiotics, drainage with chest tubes and nasogastric tubes, and operative intervention. Surgical options include operative drainage, repair of the perforation which is preferred if possible, esophageal resection, and esophageal diversion.