Perforated acute necrotizing esophagitis is a condition with several proposed etiological factors, hypothesized to be caused by weakened mucosal defence mechanisms and hemodynamic insult, leading to subsequent ischemia. We present a patient with acute necrotizing esophagitis, where underlying cardiovascular comorbidity and patient delay serve as potential contributing causal factors to the perforation. To prevent subsequent circulo-respiratory collapse and multi-organ failure, emergency esophagectomy was required, given that control of persistent leakage and mediastinitis was unlikely if managed conservatively.
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