Six patients with major esophageal leaks associated with pleural and mediastinal abscesses were treated by means of fluoroscopically placed drainage tubes. In each patient, large-bore sumps were positioned in the esophagus to obtain optimal diversion of enteric contents. Mediastinal and pleural collections were drained percutaneously or with catheters passed through the esophagus and across the esophageal rent. Closure of the esophageal disruption without further surgery was achieved in all patients.