ABSTRACT Spontaneous rupture of the esophagus is relatively rare, ranging from 2-3% of all cases of esophagus damages with mortality rate above 90% due to the development of severe complications, such as purulent mediastinitis, sepsis, pleural empyema, pericarditis, erosion of large vessels of mediastinum and multiorg an failure. 22 patients with spontaneous esophagealrupture were treated in Voronezh Regional Clinical Hospital No.1in the period from 1998 to 2017. All patients were divided into 4 groups: group 1 - 8 patients who underwent pleural cavity drainage; group 2 - 2 patients with suturing of the esophagus wounds; group 3 - 2 patients who underwent suturing of the esophageal wall defect, fundoplication with covered stitches by the bottom of the stomach; group 4 - 10 patients with perforated hole not sutured, but a cuff was formed from the bottom of the stomach, covering the perforation (fundoplication according to Chernousov), the pleural cavity was drained. Among the patients of group 1, the mortality rate was 62.5% (5 patients). In patients of group 2, suture failure and mortality - 2 patients (100%). In patients of group 3, failure of the esophagus and cuff sutures occurred in 2 patients (100%), 1 of them died. 2 patients (20%) died among the patients of group 4. The obtained data showed that the most effective method of surgical treatment of patients with esophageal rupture is the method of forming a cuff from the bottom of the stomach, covering the perforation without suturing the perforated hole.