We report the clinical presentation and unusual mechanism of a new case of spontaneous rupture of the esophagus. The initial clinical picture was suggestive of a gastric volvulus in a context of severe circulatory failure, but subsequent occurrence of subcutaneous cervical emphysema led to the diagnosis of spontaneous rupture of the esophagus. Laparotomy revealed an unusual etiopathic mechanism whereby the rupture of the esophagus resulted from strangulation within the collar of a complicated hiatus hernia, with secondary ischemic necrosis. Despite surgery 22 h after admission and symptomatic treatment, the patient died of septic shock and multiple organ failure 9 days after. This case emphasizes yet again the seriousness of this condition and the absolute necessity for early diagnosis and surgical treatment.