Classification of esophageal injury recognizes three major categories of causes: penetrating trauma, chemical trauma and foreign body ingestion injuries. Penetrating trauma includes gunshot wounds, stab wounds, and medical instrumentation injuries from endoscopic procedures. Blunt trauma occurs by dramatic pressure changes within the esophagus. Chemical traumas include those from ingestion of a caustic material that causes injury to the entire esophagus. Foreign body ingestion may cause a laceration or puncture to the esophageal wall. Iatrogenic esophageal perforation is the most common cause of perforation. It may result from esophageal instrumentation such as endoscopy and dilatation of esophageal strictures or achalasia, or surgical dissection around the esophagus in the course of other operations as abdominal vagotomy, hiatal hernia repair or antireflux procedures. Thoracic esophagus is more likely to be injured than cervical esophagus especially its lower third and becomes more susceptible to be injured by underlying disease, as it becomes more fragile. Abdominal esophagus is the least common part to be injured.