Chest pain after a full meal is a major manifestation of spontaneous esophageal rupture. Spontaneous esophageal rupture is a full longitudinal tear of the left wall of the esophagus adjacent to the diaphragm due to a sudden increase in pressure in the lumen. It is also known as Boerhaave’s syndrome, spontaneous esophageal tear syndrome, and pressure rupture of the esophagus. Most of them occur after alcohol consumption and vomiting. The initial symptoms are vomiting, nausea, epigastric pain, and chest pain. 1/3 to 1/2 of patients have vomiting blood. Patients who vomit can often have a history of alcohol consumption or overeating. The location of the pain is mostly in the upper abdomen, but it can also be behind the sternum, in the two quarter ribs, in the lower chest, and sometimes radiates to the back of the shoulder. In severe cases, there may be shortness of breath, dyspnea, cyanosis, and shock. Spontaneous rupture of the esophagus almost always occurs with a sudden increase in intra-abdominal pressure. The speed of the pressure rise is more important than the absolute value of the pressure rise. A sudden increase in intra-abdominal pressure is more dangerous in a stomach that is full of food after a meal, because a food-filled fundus is less able to tolerate the increase in pressure. The most common cause is vomiting (70%-80%). When vomiting occurs, the pylorus contracts so that the stomach contents cannot be pushed downward, while the diaphragm and abdominal muscles contract sharply, resulting in a rapid increase in intra-abdominal pressure. Therefore, prevention of sudden rise in intra-abdominal pressure is the key to prevention.