The authors present a case of the tension pneumofluidothorax followed by a right pleural cavity empyema resulting from a rupture of the oesophagus during a major gastrectasy. The gastric dilation was indicated for a pyloro-duodenal stenosis following a duodenum-preserving resection of the pancreatic head, which was completed six years ago for a chronic pancreatitis. The symptoms developed fully shortly after lifting a heavy weight.