It may have been surpassed as the hottest chili in the world, but the notorious ghost pepper showed it still packs a powerful punch after forcing a man to undergo emergency surgery to repair an inch-wide hole in his esophagus.

The 47-year-old American was taking part in an eating contest at a restaurant in the San Francisco area, where he consumed the ghost pepper, or bhut jolokia, as a puree on a burger. While he completed the challenge, he immediately felt intense burning in his mouth. After six glasses of water failed to quell the effects, he started vomiting so violently that it tore the hole in the canal connecting the throat to the stomach.

When his condition failed to improve upon initial treatment at the emergency department at the University of California at San Francisco, the patient was rushed into surgery where it was also discovered that his left lung had collapsed. Fortunate merely to survive, the man was forced to spend 23 days in the hospital before being released with a gastric tube in place.

Describing the man's case in a report published on Sept. 29, the Journal of Emergency Medicine notes that there have been “no significant adverse effects of ghost pepper ingestion.” However, it warns of the dangers of spontaneous esophageal rupture, known as Boerhaave syndrome, which has an extremely high mortality rate, initially being interpreted as mere discomfort after eating spicy food.

The ghost pepper was considered the hottest chili in the world until 2013, when it was surpassed by the Carolina Reaper pepper. The thumb-sized pepper has a measured heat of 1 million Scoville heat units (SHU), which is twice the strength of a habanero pepper and around 100 times hotter than a jalapeño. In its native India, the bhut jolikia is often used in curries and is seen as a remedy to the intense summer heat.

India has also found another use for the pepper. In 2009, it was used as an ingredient in grenades. When deployed, the chili grenade explodes with dust so potent that it leaves subjects struggling to breathe and blinded for several hours.

“The chili grenade is a non-toxic weapon and when used would force a terrorist to come out of his hideout” R.B. Srivastava, a lead scientist from India’s Defense Research and Development Organization, said at the time. "The effect is so pungent that it would literally choke them."