Introduction and importance: High-quality cardiopulmonary resuscitation (CPR) is the foundation of cardiac arrest resuscitation. Pneumoperitoneum due to gastric perforation is a rare surgical complication of CPR that, if left untreated, can result in significant morbidity and mortality. Case presentation: We present a 51-year-old male patient with sealed perforation who received an urgent but non-diagnostic exploratory laparotomy after initial esophageal intubation and resuscitation in cardiac arrest, despite significant evidence of surgical pneumoperitoneum. Clinical discussion: It is unusual to experience spontaneous pneumoperitoneum after cardiopulmonary resuscitation. We should promote cardiopulmonary resuscitation training for both medical and non-medical personnel. Conclusion: Early endotracheal intubation, avoidance of esophageal intubation, and quick insertion of an orogastric tube may reduce the risk of gastric perforation