Gastric perforation is a life-threatening condition and is rarely seen in children. In this case report a two-year-old girl with a two-day history of fever and severe abdominal pain was evaluated in an emergency department. When she was four months old, she had surgery for malrotation. On examination the abdomen was distended, and her condition deteriorated rapidly with signs of shock. A computerised axial tomography scan revealed pneumoperitoneum, and intraoperative findings proved gastric perforation. Surgery was successful. Early diagnosis, surgery, and antibiotic therapy are important in cases of gastric perforation in children to avoid fatal complications.