Boerhaave's syndrome is difficult to diagnosis because of the esophageal rupture, which is caused by nausea and vomiting, and Boerhaave's syndrome is known to have a high mortality rate. The mortality increases with a delayed diagnosis; therefore, an early diagnosis and surgical treatment are critical for a good prognosis. Yet some recent cases have shown that non-surgical treatments are successful in some classified patient groups. These groups should be considered according to their symptoms and their laboratory and radiological findings. Sepsis and multi-organ failure should be continuously checked for to see if they occurred and/or progressed. We report here on a 51 year old woman who had Boerhaave's syndrome, and this was caused by heavy drinking, nausea and vomiting, and she improved with just non-surgical treatment such as fasting, antibiotics and endoscopic clipping. (Korean J Gastrointest Endosc 2008;37:409-412)