We present 3 consecutive cases of fishbone perforation of the esophagus that resulted in acute mediastinitis. All patients were successfully managed with drainage and debridement of the mediastinum and pleural cavity. However, temporary exclusion with external ligation of the esophagus was also performed in one patient, with spontaneous recanalization two weeks later. We discuss the possible role of this surgical maneuver in the management of esophageal perforation.