Background Emphysematous gastritis is a rare and severe form of gastritis with a high mortality rate of up to 55%. It can occur in patients with poorly controlled diabetes mellitus (DM) with gastroparesis. This condition is challenging to diagnose, and optimal treatment remains unclear. Method This is a single-patient case study completed at a metropolitan tertiary hospital. Result A 39-year-old female presented with a two-day history of epigastric pain and nausea. She had a history of poorly controlled T1DM with gastroparesis. Examination showed a soft but distended abdomen and epigastric tenderness without generalised peritonism. Vital signs were normal. Blood tests showed elevated inflammatory markers (WCC of 19.9 x 109/L and CRP of 68 mg/L) but no evidence of diabetic ketoacidosis. A CT scan of the abdomen showed emphysematous gastritis with small volume perforation along the lesser curvature of the stomach and normal duodenum. She received a trial of non-operative management with bowel rest, proton pump inhibitors, and broad-spectrum antibiotics whilst managing DM. She was advanced to a solid diet and discharged on day five of admission. Outpatient gastroscopy at one month showed resolving emphysematous gastritis with biopsies negative for malignancy and Helicobacter pylori infection. Conclusion This is the first reported Australian case of emphysematous gastritis related to diabetic gastroparesis to our knowledge. Early recognition and prompt supportive therapy may help prevent progression of emphysematous gastritis. A case-by-case approach is needed to evaluate the appropriateness of non-operative management. Further research is required to provide surgeons with evidence-based approaches for this unique condition.