An 89-year-old man with early esophageal squamous cell carcinoma, measuring 20 mm in diameter in the lower thoracic esophagus was admitted to our hospital. Endoscopic Submucosal dissection was performed under sedation. After dissection, a pinhole was found in an esophageal ulcer by endoscopy. Vomiting by the patient caused esophageal rapture from this pinhole, resulting in tearing of one-third of the circumference of the esophagus. To avoid surgery, two nasogastric tubes were inserted for local drainage. One tube was placed below the perforation to irrigate saline, and the other was placed in the stomach for suctioning. Continuous flushing with saline was performed. Computed Tomography showed free air over a wide area of the mediastinum and pneumothorax. There was no abscess, and healing of the wound was confirmed endoscopically on post-ESD Day 40. This drainage method is assumed to be effective when conventional methods would be ineffective.
