Spontaneous rupture of the esophagus is a serious acute disease which occurs preferably in the lower esophagus. The disease causes mediastinal and intrathoracic contamination, requiring drainage for treatment. We experienced four operated cases of spontaneous esophageal rupture in these seven years. In latter two cases, which presented peripleural abscess on postoperative computed tomography, ultrasonic drainage was successfully performed. Diagnosis of whether or not a peripleural abscess has been newly developed is important, if infectious findings persist or recur after operation for spontaneous esophageal rupture. Peripleural abscess was presumably formed by the bilateral influx of mediastinal contaminant from the vertebral body due to supine posture.