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Editor,—Drs Onyeka and Booth present an interesting case of tension pneumothorax associated with Boerhaave's syndrome.1 I have previously described a similar case in a 47 year old man who survived his ordeal in 1996.2 As the authors note, awareness of the condition is the mainstay of diagnosis.
Aside from these two cases, tension pneumothorax has been described in association with rupture of a Barrett's oesophagus3 and after rupture of an oesophageal diverticulum.4 It is worth noting that by far the commonest cause of oesophageal rupture is after endoscopy. Regardless of the cause of rupture I agree with the authors that a gastrograffin oesophogram is the diagnostic procedure of choice.
Conservative management of oesophageal rupture is now a well established option in iatrogenic rupture and has been described in Boerhaave's syndrome,5, 6 although as the authors note, immediate surgery comprising drainage and repair is the mainstay of curative treatment.