Endoscopy is frequently used for the foreign body in the food passage, however, unexpected complication has often ensued. Due to its anatomical relationship even the trivial complication might cause a serious outcome that extraordinary caution should be given on its usage. As frequent complication during endoscopy, periesophagitis, periesophageal abscess, mediastinitis, pneumothorax, pneumonia, lung abscess and subcutaneous emphysema are frequently ensued and any of these might cause a fatal outcome, though antibiotics and improbed thoracosurgical technique have brought much favorable outcome for these complication. The authors have recently experienced a case of acutely developed complicated mediastinitis after removal of a coin from the first isthmus of the esophagus and this is the report of this case along with literature survey.