A 78-year-old woman was admitted to our hospital with severe back pain. She previously underwent distal gastrectomy for gastric cancer at the age of 53. Contrast enhanced CT revealed acute type B dissection extending from distal arch aorta to abdominal aorta. False lumen was thrombosed and there were no main visceral artery stenosis or bleeding. She was treated medically with stable condition at admission. On 4th day after onset, she had dyspnea and hypotension requiring inotrope infusion and respiratory support. Contrast enhanced CT showed abnormal intramural gas in esophagus and fluid accumulation in the mediastinum with severe lung edema. Endoscopic examination revealed necrosis in esophagus. Immediately she underwent proximal esophagus closure and gastric tube drainage for esophagus rupture. However her septic shock and acute respiratory distress syndrome was worsening and she died of multiple organ failure on 22 days after admission. Acute esophageal rupture was thought to be caused by esophagus ischemia due to acute aortic dissection with thrombosed false lumen at descending aorta. Esophagus ischemia caused by acute aortic dissection is extremely rare but it should be considered as same as intesitinal ischemia.