A full-term neonate with perinatal asphyxia (no hypoxic ischaemic encephalopathy and meconium aspiration syndrome who developed klebsiella sepsis on D2 of life was documented to have a massively dilated stomach on abdominal X-ray and large gastric aspirates. A gastroconray study ruled out gastric outlet obstruction. As the sepsis settled the gastric aspiratres and the gastric size decreased suggesting that klebsiella sepsis was the cause for localised gastric ileus that resulted in massive gastric dilation. The aetiopathogenesis and differential diagnosis of localised gastric ileus are discussed.