A patient recently underwent an endoscopic procedure following which esophageal perforation occurred. Which is the most common site of esophageal perforation in this case?

Most common site of esophageal perforation during endoscopy is through the posterior wall of cervical esophagus. Other common sites includes narrowing at the level of aoic arch and gastroesophageal junction. In Mallory Weiss syndrome and Boerhaave syndrome esophageal rupture usually occur in the lower esophagus or cardia of the stomach. Patients with esophageal rupture can present with a classical triad of vomiting, lower chest pain and subcutaneous emphysema. On examination Hamon's crunch might be present, it indicates a crunch like sound caused by the presence of air moving within the mediastinum. Diagnosis usually require esophageal fluoroscopy using water soluble contrast. If the initial study is negative barium esophagogram should be performed. Ref: Head & Neck Surgery: Otolaryngology edited by Byron J. Bailey, 4th edn, page 768