A 33-year-old woman presented to the emergency department with severe abdominal pain. She had a history of binge eating due to wedding preparation- related stress. She had consumed heavy meals, for more than 3 hours, following which she developed severe epigastric pain. Initial abdominal radiograph revealed a massively distended stomach without perforation (Fig. 1A); therefore, rapid decompression with gastric lavage (about 6 L) was performed for 1 hour. Abdominopelvic computed tomography (CT) showed distended stomach with diffuse intrahepatic portal vein gas (PVG) (Fig. 1B). The patient agreed to perform further evaluation, and esophagogastroduodenoscopy (EGD) revealed dark-colored mucosa and diffuse edema with shallow ulceration along the greater curvature of the stomach, suggesting severe ischemia (Fig. 2A). Empirical intravenous antibiotics and proton pump inhibitors were administered. The patient’s condition gradually improved with conservative management (Fig. 1C). On the 7th day, EGD showed improved gastric ischemia (Fig. 2B), and she was able to consume liquid diet. On the 13th day, CT showed no evidence of PVG (Fig. 1D) and the patient remained stable.