Esophageal disruption by foreign bodies is often life-threatening, and emergency surgery may be necessary. Staged reconstruction is 1 of the choices of treatment following the acute stage. The advantages of colon interposition include lower reflux incidence, nearly unlimited conduit length, and preservation of gastric reservoir functions. Late complications, including anastomotic stricture, redundancy on the skin flap, and reflux, are well documented. Spontaneous colic arterial hemorrhage causing mesocolonic hematoma has been reported, but is extremely exceptional. We report a 50-year-old male who developed mediastinal hematoma caused by hemorrhage from a small interposed branch of the colic artery 17 years after colon interposition treatment for esophageal perforation.