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Iatrogenic esophageal traumas are the most common of esophageal perforation, accounting for up to 60% of cases from which endoscopic perforations are about 70%. Despite modern surgical advanced techniques, perforation of the esophagus still represents a true surgical emergency and this condition is associated with a mortality of 20-30%. Early and accurate diagnosis and treatment of esophageal injuries are critical. Indirect signs of esophageal injury can be seen on a posteroanterior and lateral plain chest X-ray. Such signs include pleural effusion, pneumomediastinum, subcutaneous emphysema, hydrothorax, pneumothorax and collapse of the lung. Computer Tomography (CT) of the chest and upper abdomen with oral contrast can also show a leak and confirm the chest X-ray findings. Three approaches are available for the treatment of esophageal perforation: conservative, endotherapy, and surgery. Surgery is mandatory in any part of the esophagus when the perforation is large or when patients do not improve with conservative or endoscopic treatment. We present our case who survived a massive thoracic esophageal tear during endoscopic intragstric balloon insertion. Emergency right thoracotomy was done; we found an inflated gastric balloon perforating the thoracic esophagus and protruding in the right thoracic cavity with a big longitudinal esophageal tear. The tear was primarily repaired with suture of perforation with reinforcement flaps. We conclude that; iatrogenic traumatic injuries of the esophagus is rare but could be life threatening and must be managed by multiple disciplinary teams. Urgent surgical esophageal repair is the treatment of choice in big thoracic esophageal tears. This is the 1st case documented with esophageal rupture due to intragastric balloon insertion.

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