Spontaneous esophageal perforation of a Barrett's ulcer is a rare condition that is associated with high morbidity and mortality. It occurs as a result of a missed diagnosis of underlying Barrett's esophagus or because of unresponsiveness to medical management. Owing to the life-threatening nature of this disease, emergency surgical intervention is indicated. Here, we report the first case of spontaneous Barrett's esophageal perforation that has been managed using a thoracoscopic approach. This case highlights the feasibility of minimally invasive methodology for emergent esophageal disorders. It also demonstrates the altered esophageal wall properties of Barrett's esophagus through musculofibrous thickening and muscularis mucosae duplication that may contribute to the technical outcomes of esophageal surgical management.
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