<prompt> In which of the following conditions operative repair is favored over conservative management?Boerhaaves syndromePerforation of cervical EsophagusEsophageal rupture confined to mediastinumFlexible endoscopic perforation of esophagus  <response>: Ans. A. Boerhaaves syndromeExplanationQuestion adopted as such from bailey and love tableThe decision between operative and non-operative management depends on four factors. These are:The site of the perforation cervical versus thoracoabdominal esophagus;The event causing the perforation spontaneous versus instrumental;Underlying pathology benign or malignant;The status of the esophagus before the perforation fasted and empty versus obstructed with a stagnant residue.Nonoperative managementOperative repairSmall septic loadLarge septic loadMinimal cardiovascular upsetSeptic shockPerforation confined to mediastinumBoerhaaves syndromeCervical esophagial perforationPleura breachedPerforation by flexible endoscopePerforation of abdominal esophagusBoerhaaves syndrome:This occurs classically when a person vomits against a closed glottis. The pressure in the esophagus increases rapidly, and the esophagus bursts at its weakest point in the lower third, sending a stream of material into the mediastinum and often the pleural cavity as well. The condition was first reported by Boerhaave. A large volume of material is released into the mediastinum, which causes rapid chemical irritation in the mediastinum and pleura followed by infection if untreated. 