The case described herein underscores the importance of early endoscopy when intramural gastric air is detected by radiography. Although gastric pneumatosis is an uncommon finding, when it is detected, clinicians must be aggressive in determining the underlying etiology so that appropriate interventions are initiated in a timely manner. In this case, the gross endoscopic appearance of the mucosa and the unique histological findings were critical in establishing the correct diagnosis. Although gastric pneumatosis has been found in surgically resected specimens, the first description of histological findings associated with gastric pneumatosis in endoscopically obtained biopsies is presented in this report. This report also documents how rapidly both endoscopic and histological abnormalities, associated with this entity, can resolve.