Gastric perforation in the equine neonate is virtually 100% fatal with only 1 report of successful surgical repair in a foal that was subsequently euthanized 6 weeks post-operatively. This report describes a gastric perforation in a 2-day old Thoroughbred colt that was successfully surgically repaired, with a survival time at publication of 2 months. Differential diagnoses for gastric perforation including gastroduodenal ulceration disease are discussed, as are long-term complications of abdominal surgery in foals.