<prompt> 85A middle aged man complains A upper abdominal pain after a heavy meal There is tenderness in the upper abdomen and on X ray widening of the mediastinum is seen with pneumo mediastinum what is the diagnosis?spontaneous perforation of the esophagusPerforated peptic ulcerForiegn body in esophagusRupture of emphysematous bulla  <response>: Spontaneous peroforation of esophagus Boerhaave;s syndrome patient can present with retching subcutaneous emphysema can pain On X rays pneuma mediastinum can be seen ref : bailey and love 27th ed. 