In cases of acute gastric dilatation the progression of symptoms is rapid and prompt relief is necessary. Since the pathogenesis of the condition is poorly understood, however, treatment is still empirical. The most effective measure is to intubate the stomach and to remove the accumulated secretions and gases by continuous suction. Dilatation of the stomach has frequently followed abdominal surgery in the past, but three case histories here presented show that it sometimes follows other trauma, especially in patients immobilized for various reasons. In the fourth case, that of a 69-year-old woman, no obvious cause was found, but the condition progressed rapidly to a fatal termination. Acute dilatation of the stomach is a serious condition that is easily diagnosed and should be treated promptly.