A 50-year-old man had drinks followed by a heavy dinner. He had severe vomiting and chest pain and collapsed. X-ray of chest showed hydropneumothorax. The likely diagnosis is:

Severe vomiting can cause tear of oesophageal mucosa only (Mallory-Weiss syndrome) or tear of all the layers of oesophageal wall (Boerhaave syndrome) above the diaphragm due to sudden increase in oesophageal pressure. Since there is hydropneumothorax, all the layers of oesophagus are torn. Oesophagogram with water-soluble die will show tear located just above the diaphragm. Small tears may be missed unless barium is used.Treatment of Boerhaave syndrome is thoracotomy, repair of the tear and mediastinal drainage. Systemic antibiotics should be used to control infection.