Background
Esophageal perforation is a rare but life-threatening condition1. Early detection and diagnosis are important to ensure good patient outcomes. At least half of esophageal perforations are iatrogenic, oftentimes caused by endoscopic instrumentation use in the upper gastrointestinal tract1. Still, about a third of esophageal perforations are spontaneous1. The scientific evidence that steers management of esophageal perforation is based primarily upon retrospective studies at single institutions, as well as on a few nationwide studies1-8. Randomized studies are virtually non-existent1. The case that we present is of a patient that was eventually found to have a contained esophageal perforation instead of the initially suspected retropharyngeal abscess.