Introduction Non-Occlusive Mesenteric Ischaemia (NOMI) is a life-threatening surgical emergency which can be rarely induced by the use of Methamphetamine. It is associated with a high mortality rate if not managed properly. Patients with methamphetamine-induced NOMI usually present with non-specific symptoms that can easily overlap with other gastrointestinal emergencies. The absence of overt thrombus in imaging further complicates early diagnosis. Because of these factors, methamphetamine-induced NOMI can be particularly challenging to diagnose and manage. Case presentation We present a case of a 55-year-old male who presented with a 1-day history of sudden onset, generalized, colicky abdominal pain associated with fever, tachycardia and multiple episodes of vomiting. The patient was a regular intravenous drug user (IVDU) with a history of methamphetamine use. The abdominal computed tomography mesenteric angiogram scan showed no evidence of arterial thrombosis or other surgical pathology. The patient underwent an urgent laparotomy due to clinical suspicion of methamphetamine-induced NOMI. The operation revealed a dilated colon with multiple necrotic segment in the splenic flexure, sigmoid colon, rectum and distal small bowel. The patient underwent a subtotal colectomy followed by multiple re-look laparotomies and end ileostomy formation. Histopathology confirmed the diagnosis of acute bowel ischaemia. The patient survived and was discharged home 40 days after the initial presentation. Conclusion We describe a rare case of Methamphetamine-Induced NOMI successfully managed by emergency subtotal colectomy. Improved awareness of this rare presentation may facilitate better clinical outcomes, avoiding morbidity from delayed diagnosis.