Boerhaave's syndrome is described as a spontaneous rupture of the esophagus. It usually occurs in the left posterolateral wall of the distal esophagus and results in fulminant mediastinitis if immediate treatment is not administered. We report a case of pneumoperitoneum caused by a rupture of the anterior wall of the esophagus in a young male patient. In spite of the delayed detection, the patient was hemodynamically stable and treated via an endoscopic procedure. The limited lesion in the abdomen is possibly related to the anatomic site of the rupture. It is uncommon that a spontaneous esophageal perforation occurs at the anterior wall. Moreover, subdiaphragmatic spontaneous perforation has also been reported infrequently. To the best of our knowledge, only a few reports have described a spontaneous intra-abdominal perforation of the anterior wall of the esophagus. We report a rupture of the anterior wall of the esophagus and consider the relationship between the site of the rupture and the clinical manifestations.