BackgroundTransesophageal echocardiography is widely used in cardiac surgery. Transesophageal echocardiography probe insertion and manipulation can injure the esophagus.Case presentationA 76-year-old Asian man was admitted to our hospital for coronary artery bypass graft revascularization surgery. A right carotid endarterectomy was successfully performed 2 days before coronary artery bypass graft revascularization surgery. After the coronary artery bypass graft revascularization surgery was done successfully, postoperative computed tomography and esophagography revealed perforation of the middle esophagus. The patient was managed with fasting, parenteral nutrition, and intravenous antibiotics.ConclusionsEsophageal perforation can occur with transesophageal echocardiography probe insertion, even without difficulty or resistance, in patients with atherosclerotic disease. Appropriate imaging and vigilance for esophageal injury after a transesophageal echocardiography examination in patients with cardiovascular disease are necessary for appropriate diagnosis and treatment.