Esophageal perforation is a serious medical condition characterized by a tear or hole in the muscular layer. This case report details the presentation, diagnosis, and treatment of a patient with missed esophageal perforation at an emergency department. The report highlights treatment options, missed findings from the chest X-ray, and relevant case details. Management primarily depends on prompt detection and intervention through conservative measures or surgical repair. Identifying the issue within the initial hours after presentation can significantly decrease the mortality rate, which can be as high as 30%.