An adult, female, reef manta ray (Manta alfredi) was evaluated for abnormal swimming and coelomic distention after colliding with a floating dock in an exhibit. Initial clinical signs included abnormal posture and swimming. Clinical signs progressed to include muscle wasting, poor body condition, and coelomic distention. Further diagnostics revealed excessive exhibit substrate within the gastrointestinal tract, gastric ulcers, free coelomic fluid, possible spinal lesion, possible uterine abnormality, and hematologic changes. The ray was treated with repeated gastroscopic examinations to remove substrate from the stomach. Psyllium and mineral oil were administered in gel food to assist with passage of substrate through the gastrointestinal tract. Gastric ulcers were treated with sucralfate. Vitamin B complex, iron dextran, and Yunnan Paiyao were used to treat the anemia. Amikacin and sulfadimethoxine-ormetoprim were administered for suspected bacterial and coccidial infections, respectively. Over the course of 11 mo the ray returned to normal health.