Mr. Chen from Hong Kong went to Beijing to visit his family and friends before the Chinese New Year, but unexpectedly suffered from severe chest and abdominal pain due to vomiting after drinking alcohol. After examination, it was found that Mr. Chen had a spontaneous esophageal rupture, which was life-threatening if he did not have immediate surgery. So he immediately underwent emergency surgery to repair the ruptured esophagus. Recently, Mr. Chen has been discharged from the hospital. In the past two months, our department has treated three consecutive cases of spontaneous esophageal rupture. What exactly is spontaneous esophageal rupture? Spontaneous esophageal rupture refers to the sudden occurrence of esophageal rupture in healthy people. Most of the patients (70%-80%) have ruptured their esophagus due to vomiting after drinking alcohol, so violent vomiting is the most important cause, so some people call it post-vomiting esophageal rupture. Other causes include childbirth, car accidents, after cranial surgery, epilepsy, etc. The main symptoms are vomiting, nausea, chest pain or epigastric pain. 1/3 to 1/2 patients have vomiting blood. When the symptoms are severe, there may be shortness of breath, dyspnea, cyanosis, and shock. Physical examination mostly shows acute abdomen, and there may be corresponding signs of liquid pneumothorax. Due to the atypical symptoms, the clinical diagnosis is often misdiagnosed as respiratory failure, gastric perforation, acute pancreatitis, etc., which delays the treatment. X-ray chest plain film may show liquid pneumothorax on one side, mediastinal emphysema, and subcutaneous emphysema shadow in the neck. Esophageal iodine oil angiography with contrast spillage may confirm the diagnosis. Diagnostic thoracic puncture can also be performed, and the diagnosis can be confirmed if the aspirate is a bloody, acidic fluid or if food scraps are found. The treatment and outcome of spontaneous esophageal rupture are closely related to the early or late diagnosis, the size of the rupture, the amount of gastric contents entering the thoracic cavity, and the degree of contamination. The earlier the detection, the better the treatment effect. There is little chance that the esophageal rupture will heal on its own, and surgery is mostly required. Generally speaking, local esophageal repair surgery within 12 to 24 hours after the rupture occurs is most effective and often results in one-stage healing with no other sequelae. If it takes more than 24 hours, it can be complicated by abscess chest and mediastinitis, and the effect of surgical repair is not exact. Some patients may require a simple chest drainage procedure first to control the infection and improve the general condition, followed by a second procedure a few weeks later. We caution that if more severe chest or abdominal pain occurs because of violent vomiting after drinking alcohol, prompt medical attention should be sought. It is also recommended to drink alcohol in moderation so as not to have an accident or even endanger your life as a result.