First described by S.E. Duplay in 1833, acute gastric dilatation has since been well documented in the literature. Several theories of the pathogenesis of acute gastric dilatation have been postulated. In 1842, Karl Freiherr von Rokitansky described the superior mesenteric artery syndrome, followed by W. Brinton in 1859 with the atonic theory. C.R. Morris et al. introduced debilitation and anesthesia as predisposing factors. Although rare, gastric necrosis is the most severe consequence of acute gastric dilatation. Vascular insufficiency secondary to increased intragastric pressure is the critical factor. We report an unusual case of acute gastric dilatation with subsequent necrosis of uncertain etiology.