A 3.5-year-old grossly cachectic female child presenting with recurrent vomiting, fever, abdominal distention, abdominal pain and severe weight loss was evaluated for the cause of severe protein energy malnutrition. Investigation revealed a massively dilated stomach with delayed gastric emptying and normal pylorus. On exploratory laparotomy, diagnosis of primary acquired gastric outlet obstruction (Jodhpur disease) was confirmed and she underwent pyloroplasty with uneventful post-operative period. To conclude, this entity should always be included in the differential diagnosis of gastric outlet obstruction with severe malnutrition especially in older children.