A 60-year-old man presented with epigastric pain. The patient had no history of foreign body ingestion and had no symptoms of dysphagia or odynophagia. Chest computed tomography scan showed an esophageal perforation with unknown etiology and an emergency operation for thoracic cavity irrigation and drainage was undertaken, followed by fasting and conservative treatment. Two weeks later, a follow-up chest computed tomography scan revealed a suspicious foreign body in the distal esophagus. Endoscopy revealed a press-through-pack (PTP) that had caused an esophageal perforation. Despite extraction of the PTP and antibiotic administration, the patient died. The present case is important since PTP is commonly used in Korea. (Korean J Gastrointest Endosc 2009;39:355-358)