This case reports an idiopathic gastric rupture in a 3-year-old girl who had an episode of nausea and vomiting after a large meal. Abdominal ultrasound and CT scan revealed free air and fluid in the abdominal cavity, leading to the diagnosis of gastro-intestinal perforation. During emergency surgery, gastric rupture was detected on the anterior wall of the gastric body near the greater curvature and treated by performing a sleeve gastrectomy. The intra-operative course was complicated by a cardiac arrest. The child survived following intensive postoperative care. All articles on spontaneous idiopathic gastric rupture in pre-school age children have only been reported in Japanese and Chinese literature.