Oesophageal ruptures or tears carry a high mortality if they are not recognized and if therapy is delayed. This is so particularly for cases of spontaneous rupture of the oesophagus which carry a higher mortality and morbidity than do cases of iatrogenic injuries. With the widespread use of fibreoptic oesophagogastroscopy, which has been accompanied by the therapeutic manipulation of strictures and tumours, the number of iatrogenic perforations has increased substantially. We report our experience with 23 oesophageal perforations or ruptures that were seen over a 15-year period. The results of both the surgical and the conservative management of such lesions were excellent and were based on the clinical condition of the patient and on the extent of the extravasation of contrast media. Our results show that not all cases of oesophageal perforations require immediate surgical exploration and that the results of surgical treatment are excellent if the diagnosis is made early.