<prompt> 28-year-old alcoholic patient walks to hospital with the complaints of binge vomiting, chest pain, fever and X ray shows hydropneumothorax. The most probable condition;Boerhaave syndromeTension pneumo thoraxPUD perforationMallory Weiss tear  <response>: BOERHAAVE Syndrome- Aka Spontaneous esophageal perforation- Caused by Forceful vomiting Repeated vomiting- MC site of perforation - Lower 13rd of esophagus along Left posterolateral direction- More common in malesClinical features- Characterized by Macklers triad Thoracic Pain Vomiting Cervical subcutaneous emphysema- In case of massive contamination inflammation Fever SepsisInvestigation- On CXR - Hydropneumothorax- IOC for Dx - Water soluble contrast esophagogram Gastrograffin Hypaque Management- Depends on Time of Presentation Within 24 hours After 24 hours Golden period of repair Esophagostomy ICD inseion feeding jejunostomy Repair of Perforation ICD inseion Feeding jejunostomy Moality rate upto 20 Moality rate 50 