Esophageal perforation is a medical emergency, which requires fast and accurate diagnosis and treatment, according to the high rate of complications and risk of lethal outcome. It's considered a defect of the esophageal wall, through which gastrointestinal content leaks into body cavities, predisponing infection with progress into sepsis. Symptoms such as disphagia, odinophagia, retrosternal pain, subcutane emphysema, hoarsenes and indicative medical history should raise concerns about an ongoing esophageal perforation. Diagnosis is confirmed radiographically, by plain RTG, contrast esophagography and CT. Treatment can either be conservative, endoscopic or surgical. Conservative measures include restriction of all peroral intake, nasogastric tube placement, intravenous fluid restitution and parenteral feeding, intravenous application of antibiotics and proton pump inhibitors and patient monitoring. The defect of the esophageal wall is treated either endoscopically by stent placement or clipping, or surgically by primary repair. Alternative methods include diversion and T-drain placement, or seldomly, esophagectomy followed by reconstruction. Extraluminal collections are drained. The outcomes of both, non-surgical and surgical treatment seem to improve, but despite that, the mortality rate remains high.