Spontaneous rupture of the oesophagus or Boerhaave syndrome is a rare phenomenon which poses a surgical challenge. Without treatment a mortality has been reported of up to 100 per cent. Early diagnosis and treatment are therefore imperative. An aggressive surgical approach is described. Three patients were treated with good results by closure of the rupture, drainage of the mediastinum, a diverting oesophagostomy, gastric drainage and postoperative enteral feeding via a jejunal catheter.