A personal observation and the analysis of the pertinent literature form the basis of this comprehensive report of gastric wall necrosis (GWN) following selective proximal vagotomy (SPV). The incidence of this specific and ischemic sequel of SPV is 0.25%. GWN carries specific morphological criteria, shows certain predisposing risk factors of general and local type, characteristic symptoms and well defined types of clinical courses. Technical failures and delay of operative therapy contribute mainly to the present mortality of approximately 50%. The efficacy of prophylactic measures appears to be limited, whereas immediate and adequate reoperation yields a good prognosis.