We report a case of Boerhaave’s syndrome in a previously fit 57-year-old lady with an aetiological association with a co-existing duodenal ulcer. We discuss the diagnostic difficulties presented by this case, the importance of prompt diagnosis and intervention, and the problems involved in the management that are highlighted in this case. This is an extremely rare but well recognised entity. A 1980 review by Kish cited only 300 cases worldwide; a small percentage were diagnosed post mortem (John BE, Zua MS. Boerhaave’s syndrome—an elusive diagnosis. Tenn Med 1997; 90: 56–8).