This chapter covers the management of emergencies such as oesophageal perforation, acute gastric volvulus, aorto-oesophageal fistula and atrio-oesophageal fistula illustrated by cases. The management of Boerhaave syndrome is considered, which is influenced by factors like clinical condition, comorbidities, and the extent of mediastinal and systemic sepsis. Historically, mortality rates ranged from 20 to 40%, with various treatment options from supportive care to radical surgery. With the advent of minimally invasive techniques, there is a shift towards endoscopic interventions like endoscopic vacuum therapy and VAC-Stent, showing promising outcomes in recent case series. However, the choice of intervention relies more on available expertise than evidence-based algorithms. Multidisciplinary collaboration, resuscitative measures, and timely referrals to specialist centres play pivotal roles in optimising patient outcomes. The management of gastric volvulus with and without ischaemia is discussed as well as the aetiology, presentation and management of the rare and catastrophic complications of aorto-oesophageal and atrio-oesophageal fistula. The early recognition of these complications is emphasised with rapid assessment and treatment by teams with appropriate expertise.