Gas within the gastric wall is a rare condition and can occur in two entities: gastric emphysema and emphysematous gastritis. The two entities differ in their etiology, treatment and prognosis. Emphysematous gastritis is a severe condition with high mortality. We report a case of emphysematous gastritis with initial medical treatment and subsequent surgical treatment for the sequels of the inflammatory process in the gastric wall. The topic of gas within the gastric wall is discussed. (C) 2009 Elsevier Espana, S.L. All rights reserved.