Abstract
Hepatic portal venous gas (HPVG) may suggest an ominous pathology that requires immediate attention because it is frequently associated with life-threatening conditions such as mesenteric ischemia and bowel necrosis. Therefore, early recognition and accurate differential diagnosis are crucial for timely intervention. This paper presents a 78-year-old female who developed extensive HPVG with a fatal clinical course, ultimately resulting in death despite intensive medical management.