Introduction: Spontaneous rupture of the esophagus is usually a catastrophic event followed by life-threatening complications with a mortality rate reaching as high as 50%, despite the marked improvement in the availability of diagnostic techniques and therapeutic approaches.Asymptomatic paraesophageal hernias have a risk of progression to a symptomatic hernia in 14% per year, though the risk of symptoms requiring emergency surgery is no more than 2% per year. Clinical case: 78 years old man with antecedents of gastro-esophageal reflux, arterial hypertension and benign prostate hyperplasia. Complaints of acute epigastric and back pain after dinner. Rx and CT scan where performed confirming a paraesophageal type III hiatal hernia with a perforation of the gastro-esophageal junction with pneumomediastinum and a mediastinal abcess. A laparoscopic approach was performed 15 hours after the beginning of the symptoms. The perforation was repaired with primary suture and a Toupet fundoplication was performed. There were important contamination of the mediastinum.The video shows how the esophagus can be managed by laparoscopy and how complete the treatment of the mediastinal contamination can be done. Control postoperative CT scan and endoscopy are shown.The patient was discharge 15 days after surgery with normal oral intake.