The diagnosis of spontaneous rupture of the stomach should be considered in all patients developing sudden and severe abdominal symptoms and shock. From a pathological point of view, it is unjustified not to entertain the diagnosis of spontaneous rupture of the stomach in cases of rapid and unexplained death presenting a large perforation of the stomach at autopsy. Awareness and proper study of this entity, at times, may solve a puzzling medico-legal problem. Useful diagnostic criteria are: (1) absence of autolytic changes throughout the body, (2) the size and the site of the perforation, (3) thinning of the surrounding gastric wall, (4) diastasis of the muscular layers around the perforation, (5) marked irregularity of the margins of the rupture, and (6) histological evidence of intramural hemorrhage, edema, or dissociation and disruption of muscle bundles, without inflammatory changes.