Gastric pneumatosis is a rare finding, and clinicians, when under pressure, find it challenging to immediately identify the cause and decide if the patient requires emergency surgery. We present a case where an initial CT scan demonstrated gastric pneumatosis involving only the greater curvature of the antrum caused by a strangulated hiatus hernia and malrotation of the distal stomach. The CT features suggested the patient required immediate surgery
however, a conservative approach was taken, and a follow-up CT scan 4 days after the onset demonstrated complete resolution and no long-term complications.