We report the case of a 33-yr-old man who presented with an acute incomplete esophageal obstruction, mimicking food impaction, who was found to have a giant intramural esophageal leiomyoma. The leiomyoma was successfully removed through a longitudinal esophagotomy. This is the first report of a nonpedunculated intramural esophageal leiomyoma presenting as an acute esophageal obstruction.