This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: NEET Jan 2020, Subject name: Surgery
A middle aged man complains of upper abdominal pain after a heavy meal. There is tenderness in the upper abdomen and on X-ray, widening of the mediastinum is seen with pneumo-mediastinum. What is the diagnosis? 
Select and explain. 
A. Spontaneous perforation of the esophagus, B. Perforated peptic ulcer, C. Foreign body in esophagus, D. Rupture of emphysematous bulla
A: Spontaneous perforation of the esophagus
Answer: A: Spontaneous perforation of the esophagus 
Explanation: Above clinical scenario is suggestive of diagnosis of spontaneous perforation of the esophagus. Aka BOERHAAVE Syndrome - Caused by Forceful vomiting Repeated vomiting - Clinical features - Characterized byMackler's triad Thoracic Pain Vomiting Cervical subcutaneous emphysema Investigation - On CXR - Hydropneumothorax - IOC for Dx - Water soluble contrast esophagogram (Gastrograffin > Hypaque)