Abstract:We experienced a case of Boerhaave's syndrome. The patient, a 47‐year‐old male, vomited after drinking a large quantity of alcohol and thereafter, complained of epigastralgia, back pain, and dyspnea. Leukocytosis, positive CRP, fever, tenderness of the upper abdomen and muscular defense were noted on admission. Endoscopy revealed an ulcer at the lower esophagus. Since a chest X‐P and CT showed thoracic effusion and subcutaneous and mediastinal emphysema, rupture of the esophageal ulcer was suspected. The diagnosis of Boerhaave's syndrome was established by esophagography. A rupture along the longitudinal axis of about 3cm was found at the left posterior wall 3cm above the E‐G junction, and was surgically sutured.Of many cases of Boerhaave's syndrome reported in the literature in Japan, endoscopy was performed in 70 cases. Recently, endoscopy has been adopted as the first choice for the diagnosis of this syndrome as well as for emergency examination of the esophagus and the diagnosis is established by endoscopy alone in many cases. Actually endoscopy was useful for the diagnosis of this disease in 88.2% of the above cases. These results as well as our case indicate diagnostic value of endoscopy, if performed carefully.Boerhaave's syndrome,E