Objective To study gastric rupture, a progressive, rapid and high mortality condition, caused by acute gastric distention (GRAGD) and its appropriate diagnosis and treatment. Methods The etiology, pathology, clinical manifestations and expeniences in 3 children with GRAGD were reviewed. Results Case 1: After diagnosising GRAGD and stabilizing her shock with massive fluid replacement, gastrostomy was performed. Her postoparative course was uneventful because of fasting, suction, fluid infusion, correction of acidosis and supporting natrition. Case 2: After diagnosising gastric distention which subsided With conservative therapy for 9 days, she suddanly had gastric rupture when she had not eaten for 6 days. She died of shock and had no chence for surgery. Case 3: The patient had sudden abdominal pain, distention end vomitting with severe shlock for 4 days. Emergency surgery found gastric rupture and the method was the same as Case 1. The patient survived but has brain impairment. Case 1 and 3 showed multifiocal transmural necrosis. Conclusions Syrnptoms like overeating, bulimia, changes in kind of food, X-ray showing large distended stomach and massive pneumoperitoneum were seen after pastric rupture and can help to diagnose this condition. Clinical course of gastric dislention with toxic shock progresses rapidly, hewever subsequent gastric rupture exacerbates the shock and makes the treatment difficult treatment.It is extremely important that a laparotomy he performed at once after stabilizing shock with massive fluid replacement. Postoperative nutritional support and fluid replacement will increase survival. It is very important that when gastric distenition disappears after conservative therapy,the doctor should assess carefully whether the gastric wall recovery is under way by using effective methods of examination.