Boerhaave Syndrome

A 54-year-old man presents to the emergency department 6 hours after forceful retching and vomiting during a heavy meal. He reports sudden onset of severe retrosternal and epigastric pain radiating to the left shoulder, dyspnea, and neck swelling. On examination, a crunching sound synchronous with the heartbeat is heard on cardiac auscultation (Hamman sign). Chest X-ray shows left pleural effusion and pneumomediastinum. CT with water-soluble oral contrast reveals extravasation from the left posterolateral distal esophagus 3–5 cm above the gastroesophageal junction. The condition marked **B** in the diagram is suspected. Which of the following is the MOST APPROPRIATE immediate management for this hemodynamically stable patient presenting within 24 hours of symptom onset?

A 45-year-old man presents to the emergency department with sudden-onset severe epigastric pain and left lower chest pain radiating to the back, following a bout of forceful vomiting after heavy alcohol consumption. On examination, there is crepitus palpable in the neck and left chest wall. Chest X-ray shows pneumomediastinum with left pleural effusion. The structure marked **A** in the diagram represents the pathology in this patient. Which of the following best describes the mechanism of injury in this condition?