Esophageal rupture is a rare emergency disorder. The leakage of gastric contents and foods can cause severe mediastinitis and pyothorax, occasionally resulting in the development of systemic sepsis and shock within hours. Iatrogenic injury to the esophagus is the most frequent cause of esophageal rupture, followed by spontaneous rupture. A plain chest roentgenogram, esophagogram, and chest computed tomography (CT) are necessary for the diagnosis of esophageal rupture, and early diagnosis reduces the rate of complications and mortality. The principle treatment is surgery. Drainage of the contents causing contamination, debridement of the infected tissue, and reinforcement of the primary closure of the ruptured lesion are essential for successful management. Spontaneous esophageal rupture frequently occurs on the left side of the lower thoracic esophagus. Rupture of the overlying pleura sometimes leads to systemic sepsis and shock. Iatrogenic rupture is commonly caused by endoscopic therapy. Nonoperative management is often appropriate in patients with this type of rupture.