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A 46-year-old woman presented with a history of 30-day nonsteroidal anti-inflammatory drug (NSAID) intake and dysphagia of 8-day progression. Her endoscopic study found a long (12 cm) concentric stricture 22 cm from the dentary arcade for which a gradual dilatation up to 15 mm was performed with Savary-Gilliard dilators; the middle third of the esophagus was perforated during the second dilatation session and the lesion measured approximately 10 mm in diameter ( fig. 1). A chest computed tomography scan revealed pneumomediastinum and an image consistent with a perforation located at the middle third of the esophagus on the left lateral surface ( fig. 2). Antibiotic therapy was begun ଝ Please cite this article as: