AIM OF THE PAPER: To discuss the diagnostic and therapeutic aspects of spontaneous esophageal perforation. It is considered a surgical emergency with high rate of mortality. Its diagnosis can be difficult since the presentation is often non specific and can be confused with others disorders. Many strategies have been advocated for its management. Prompt diagnosis and early treatment are required to decrease the poor prognosis of this condition. A conservative therapy may be effective in selected cases. RESULTS: We described a successful non-surgical closure of a spontaneous esophageal perforation using an endoscopic stent, in an severely ill old patient. Although the treatment was delayed because of a late diagnosis, the patient survived the usually fatal condition. CONCLUSION: The key to improve the prognosis of this life-threatening emergency is the immediate and correct diagnosis and the most appropriate selection of the primary employed procedure.