Esophageal intramural hematoma (EIH) is an uncommon clinical entity among the acute esophageal injuries, and EIH predominantly occurs in middle-aged women. The pathogenesis of EIH has not been clarified, yet this. Seems to occur within the submucosal layer of the esophagus after dissection of the mucosa. EIH may occur spontaneously or secondary to trauma. Patients usually complain of a sudden onset of severe retrosternal chest pain, hematemesis, back pain or dysphagia. Most EIHs show improvement through conservative management, including fasting and intravenous hydration, and this usually completely recovers within a period of 2∼3 weeks. We report here on a case that EIH occurred after endoscopic pinch biopsy and endoscopic band ligation and this EIH was exacerbated in a patient who was taking long-term aspirin medication. (Korean J Gastrointest Endosc 2010;40: 107-110)