A review was conducted to ascertain whether patients who suffered spontaneous postemetic esophageal rupture (Boerhaave's syndrome) experienced higher morbidity and mortality than patients who had endoscopic iatrogenic esophageal perforations. Review of the records of three medical centers from 1960 to 1985 identified 11 patients with Boerhaave's syndrome (group B) and 19 with iatrogenic perforations (group E). In group B, four patients were diagnosed greater than 24 h after perforation. Nine were treated surgically; of these one died. Two group B patients who were treated conservatively survived. In group E, only four patients were diagnosed greater than 24 h after perforation. Of 19 patients, 15 were treated surgically and four, medically. In group E, three patients died (one surgically and two conservatively treated). This study suggests that there is little difference in mortality between the two groups of patients as long as the diagnosis is made early and therapy is instituted promptly.