AGGRESSIVE surgical attack is the accepted conservative management of esophageal perforation. Since Barrett1 first reported his successful treatment of a patient in 1947, the accepted concept of therapy of esophageal perforation has been drainage, primary repair of this perforation, if possible, bypass of esophageal function (gastrostomy), and high dosage of antibiotics. Recent advocates of nonsurgical management of esophageal perforation have prompted us to review our experience with the problem over the last four years at local community hospitals. Twelve consecutive cases of esophageal perforation were reviewed and form the basis of this report (Table). Of these, six followed esophagoscopy by qualified endoscopists, two resulted from foreign body ingestion, two followed transabdominal repair of hiatal hernia, one was spontaneous, and the other followed retrograde dilatation of esophageal stricture. Another case (foreign body perforation) involved an 83-year-old patient. The condition was discovered at autopsy and is not included. Diagnosis and Report