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Spontaneous rupture of the esophagus is a rare and potentially fatal condition with an overall mortality rate of 20% to 50%. We report a rare case of Boerhaave syndrome that was successfully treated with Abbott’s T-tube. Clinical Summary A 33-year-old man presented to the emergency department of a local hospital with vomiting followed by hematemesis, chest pain, dyspnea, and fever. The chest radiography and computed tomographic (CT) scan revealed opacification of the right side of the chest. Two chest tubes were inserted with drainage of purulent fluid and regression of the clinical symptoms. A CT scan performed 2 days later revealed contrast-medium extravasation from the esophagus into the right hemithorax (Figure 1, A). The patient’s condition deteriorated 24 hours later; he showed fever and a leucocytosis count of 13,000/L. He was transferred to our institution 7 days after perforation, and a right thoracotomy was performed on the same day. At operation, a fibrin peel imprisoned the lung. After decortication, a complete reexpansion of the lung was obtained. However, a 3.5-cm transmural perforation of the esophagus was found, just below the azygos vein. The defect was debrided, and a T-tube was positioned. The chest was closed with multiple chest tubes in place. One drainage tube was placed in proximity to the T-tube, and the other tubes were placed in the pleural cavity and mediastinum (Figure 1, B). The patient was fed parenterally through a central venous line, and systemic antibiotics were administered. The postoperative course was unremarkable except for sporadic peaks of fever (up to 40°C) that stopped after suspension of antibiotics. The pleural and mediastinal drains were gradually removed. The T-tube (Figure 2, A) was removed in 2 steps 3 weeks later. First, we cut and removed the portion of the short branch of the T-tube through an esophagoscopy; the large branch was removed 2 days later. After repeated negative esophagrams (Figure 2, B), the patient resumed a regular diet and was discharged on postoperative day 38 without symptoms. Discussion Boerhaave syndrome is the most lethal perforation of the gastrointestinal tract. 1 The combination of gastric acid and digestive enzymes causes mediastinitis and sepsis, which are fatal in most untreated cases. Although approximately 300 cases of Boerhaave syndrome are reported in the literature, our case is interesting for 4 points summarized in the acronym “S.T.O.P.” (ie, “stop! pay attention”): Site, Time, Operation, Prognosis. Site: In 80% of cases, the rupture takes place in the lower left portion of the esophagus, 2 to 3 cm proximal to the gastroesophageal junction. In this case, the tear was localized in the middle right portion of the esophagus just below the azygos vein. Time: Diagnosis can be difficult, and prompt recognition is vital to ensure appropriate treatment. Although our patient presented with specific symptoms of Boerhaave syndrome, he was first treated for empyema. The CT scan performed 7 days after perforation revealed contrast extravasation from the esophagus into the right hemithorax. The patient