We have experienced 32 cases of esophageal perforation from July, 1972 to June, 1982 in our Division of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine. Here we report the cases of disease, treatment of perforation and the results. The number of male patients was 17 out of 32, which is predominant to that of female. The causes of esophageal perforation are external trauma in 9 cases surgical trauma in 5 cases dilatation with bougienage, 4 cases corrosive esophagitis and stricture in 4 cases foreign body in 4 cases spontaneous rupture in 3 cases endoscopic perforation in 2 case and unknown origin in one case. The lower part of esophagus was the most frequently involved portion in our cases, [14 cases out of 32]. There was mediastinitis in 10 cases, empyema in 9, esophagorespiratory fistula in 3, pneumomediastinum in 3. The methods of treatment were primary repair of perforation, various drainage techniques, and Conservative method. The mortality rate was 15.6%. [KTCS 1982;4:440-446]