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An abdominal CT with intravenous contrast showed gastric wall with intramural gas and pneumoperitoneum (Fig. 1a), which prompted a total gastrectomy with esophago- jejunal anastomosis and Roux-Y loop reconstruction. Surgery found extensive gastric necrosis (Fig. 1b). He was admitted to the intensive care unit and he was started on meropenem, anidulafungin and norepinephrine as a vasopressor. He was weaned of vasopressors and extubated on the eleventh day of hospitalization. Histopathological analysis of the resected stomach showed necros
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