Acute esophageal perforation in a 15-year-old male who sustained 40% body burns in a gasoline explosion is reported. He experienced an acute esophageal perforation from gastric distention and esophageal reflux during initial transit to the Cincinnati Shriners Burns Institute on the second postburn day. Bilateral hydropneumothorax occurred and the patient soon expired without treatment. Prevention of this complication is best achieved by placement of a nasogastric tube and aggressive antacid therapy.