Spontaneous perforation of the esophagus is a rare manifestation of Zolling
er-Ellison syndrome (ZES). Failure to recognize its existence can lead to a
n unsuccessful treatment of the esophageal perforation. We present a rare c
ase of reflux esophagitis-induced esophageal perforation in a patient with
ZES. Presence of a gastrinoma should be considered when recurrent or compli
cated reflux esophagitis is encountered. (C) 2001 by The Society of Thoraci
c Surgeons.