We report the case of a woman undergoing general anaesthesia in whom a gastric tube became knotted within her stomach. This is a relatively unusual phenomenon, particularly when the gastric tube is used in conjunction with a supraglottic airway device. This poses a risk to patient safety. We highlight the relevant risk factors for gastric tube knotting, and suggest management options both to reduce this risk and to safely manage the patient in whom the gastric tube has become knotted.