Iatrogenic herniation of abdominal contents after transhiatal esophagectomy for the treatment of esophageal cancer is a rare complication. Its appearance in the early postoperative period is usually accompanied by acute respiratory insufficiency; herniation may develop without symptoms and the patient may have to be readmitted with signs of perforation or strangulation of the intestinal loops in the chest cavity. We report the case of a patient in this situation who developed a clinical picture of acute respiratory insufficiency and who required several exploratory procedures (fiberoptic bronchoscopy and echography) before a firm diagnosis could be made. Early diagnosis and emergency treatment reduces complications and increases survival. A lower incidence of iatrogenic herniation of abdominal contents depends on correct closure of the diaphragm. We review correct surgical treatment to decrease the frequency of this complication.