In this episode of Surgery Shelf Prep, Chris and Mars break down esophageal perforation, a rare but life-threatening emergency classically seen after forceful vomiting or esophageal instrumentation. They review the classic presentation of sudden severe chest pain, dyspnea, and subcutaneous emphysema, explain why mediastinal contamination can rapidly lead to sepsis, and walk through the high-yield diagnosis with CT or esophagography showing contrast extravasation. The episode also covers urgent management with NPO status, IV broad-spectrum antibiotics, IV proton pump inhibitor, and emergent surgical consultation, plus key differentials like Mallory-Weiss tear, myocardial infarction, aortic dissection, and pneumothorax. Perfect for shelf review and rapid recognition of this surgical emergency.