In May 202X, a 29-year-old man was transported by ambulance to his previous doctor with a complaint of black stool and chest pain. The patient was transferred to our hospital after chest computed tomography revealed mediastinal emphysema and esophagogastroduodenoscopy revealed a hemorrhagic duodenal ulcer. A hemoglobin level of 6.2 g/dL indicated anemia. The duodenal ulcer was clipped on endoscopy to achieve hemostasis. Mallory-Weiss tears with signs of healing were observed, without any visible vessels or perforations. Thereafter, a blood transfusion was required due to worsening anemia, and endoscopy was repeated. The Mallory-Weiss tears had worsened, and visible vessels were observed. These were sutured using the clip method. Following that, the patient's condition improved. Mediastinal emphysema also disappeared and he was discharged from the hospital. Increased alveolar and intra-abdominal pressures from abdominal muscle training using a medicine ball may have contributed to the onset of the disease.
