We report the case of a 14 year-old female patient who was admitted complaining of abdominal pain due to gastric distension after an episode of bulimia. The patient was diagnosed as having gastric intramural necrosis by CT. An emergency laparotomy was performed and a massive gastric necrosis and duodenal compression due to the superior mesenteric artery syndrome was found. The patient did well after total gastrectomy and Roux-en-Y procedure.