Introduction Perforation of the esophagus and rupture of the esophagus have usually been described as separate entities. By definition, perforation of the esophagus signifies an erosion of the wall of the esophagus, except when produced by trauma or by instrumentation. Rupture of the esophagus refers to a tear in an undiseased esophagus. Welldocumented reports cite pure examples of each entity. The following two cases lend impetus to the concept21that a combination of the two factors, perforation and rupture, is present, the tenet being that ulceration of the mucosa destroys the strongest layer of the esophagus, predisposing it to rupture should the intraesophageal pressure be suddenly increased by vomiting. Report of Cases Case 1. —A 16-year-old white youth was admitted to the emergency clinic of Grady Memorial Hospital at 2:30 a.m., Aug. 11, 1954. Thirty minutes prior to admission he had been hitchhiking. When a driver stopped his car