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Superior mesenteric artery (SMA) syndrome is a rare cause of proximal bowel obstruction due to duodenal compression by the SMA. The morbidity and mortality associated with delayed diagnosis and its complications make it an important differential cause for bowel obstruction. We report a case of mega-stomach secondary to SMA syndrome requiring total gastrectomy. An 18-year-old male presented with vomiting, abdominal pain and shock after a buffet. Computed tomography (CT) imaging revealed a grossly distended stomach (113 × 187 × 350mm) and a transition point at the third part of the duodenum, along with pneumatosis and portal venous gas. Emergency gastroscopy showed blood and necrotic mucosa. Laparotomy confirmed full thickness necrosis and the patient underwent a total gastrectomy with Roux-en-Y reconstruction. Postoperatively, he had a brief intensive care stay and recovered without complications. This case underscores the importance of considering SMA syndrome during presentations of acute gastric dilatation. [ABSTRACT FROM AUTHOR]