Esophageal perforation is a severe complication with a high mortality rate. According to previous reports, surgery has been the standard treatment of choice. However, medical treatment is now used more frequently due to improvements in nutritional therapy and the development of aggressive antibiotic treatment. In this report, we describe two uncommon cases in which esophageal perforation due to swallowed fish bones was successfully treated with conservative medical therapy, even though one of the cases was associated with an abscess within the mediastinum.