Emphysematous gastritis is a life-threatening disease. Although rare in incidence, it has a fulminating course with a high mortality rate. A case of a 58 year old male with emphysematous gastritis is reported. Initially, he presented with acute gastric dilatation secondary to anorexia/bulimia-like behaviour. Later, emphysematous gastritis developed. The abdominal sonographic findings, which have not been previously described in the literature, showed intramural gas and gastric wall thickening. After receiving a total gastrectomy, he had a satisfactory outcome. The present report discusses the possible aetiologic relationship between acute gastric dilatation and emphysematous gastritis, and suggests abdominal sonography to be the first choice of diagnostic measure for patients and the intramural gas in the gastric wall. This is the first case of emphysematous gastritis diagnosed by abdominal sonography.