A 71-year-old man was intubated for respiratory failure related to amyotrophic lateral sclerosis (ALS). He presented with epigastric pain, low blood pressure, and bloody aspirate from a nasogastric tube. Contrast-enhanced computed tomography (CT) showed decreased blood flow to the gastric wall and hepatic portal venous air. Emergency laparoscopy was performed for suspected gastric necrosis. During the operation, upper gastrointestinal (GI) endoscopy showed diffuse mucosal erosions, but the gastric serosa appeared intact. Because gastric full-thickness necrosis was ruled out, gastrectomy was not performed. Upper GI endoscopy showed improvement of gastric erosions on postoperative day (POD) 3, and the patient was transferred on POD 65 without any major problems.Gastric ischemia is rare because of the rich collateral blood supply to the stomach. A case of unexplained gastric ischemia that was successfully treated by exploratory laparoscopy and upper gastrointestinal tract endoscopy is described.