We report on a rare complication, gastric rupture, which developed during electroconvulsive therapy (ECT) under general anesthesia. The patient developed symptoms of gastric rupture immediately after recovery from the first ECT session. An x-ray confirmed the clinical diagnosis, and an emergency laparotomy was conducted. The patient recovered without further complications. We review the literature and discuss ECT and potential risk factors relevant to the pathophysiology of gastric rupture. Furthermore, recommendations are proposed for clinical management.