Suspected oesophageal perforation → general surgery on call team to assess the patient → proceed with CT neck, chest, and abdomen with IV and on-table PO contrast

Diagnosed oesophageal perforation:

Is the patient a candidate for non-operative management? (Criteria for non-operative management: hemodynamically stable patient, absence of sepsis, minimal symptoms, contained perforation on upper GI contrast study with return of contrast into the esophagus, no significant pleural contamination, no distal obstruction). Remember that non-operative management is considered the exception, not the rule.

If yes → admit to ICU for further treatment and monitoring. Discuss alternative feeding access. If no à Is the patient a poor operative candidate?

If yes → endoscopic stent insertion and pleural drainage

If no → proceed to surgery with on-table gastroscopy to assess the exact location of the perforation and to rule out distal obstruction. Operative approach will depend on the location of the perforation.