Recently, with the advances in diagnostic and therapeutic endoscopic techniques, there have been increasing reports of iatrogenic gastrointestinal perforation. The mortality rate of esophageal perforations is especially high, therefore, appropriate diagnosis and treatment are important, just as in cases of spontaneous esophageal rupture. We report a case of iatrogenic esophageal rupture during a hemostatic procedure for bleeding esophageal varices in a patient with liver cirrhosis, which was successfully treated by prompt surgical treatment, T-tube-based external drainage, and enteral nutrition. Attending surgeons may hesitate to opt for surgical treatment due to the high mortality and postsurgical complication rates in cases with cirrhosis of the liver, however, early surgical intervention before worsening of the patient's general condition may yield a favorable outcome.