We agree with Dr Andrew D. Muir and Alastair Graham that the cornerstone of management of oesophageal perforation is prompt diagnosis. We also agree with them that resuscitation measures as they describe must be the management before referring the patient to a thoracic surgery department. However, the main message to give is that oesophageal perforation is a surgical emergency. Mediastinal and pleural lavage with debridment of necrotic tissue is the main treatment of pleural and mediastinal abscess and one of the main aims of resuscitation is to allow the patient to undergo that surgical treatment as soon as possible [1].