Abstract
Hepatic portal venous gas (HPVG) is a rare but significant radiological finding traditionally associated with severe abdominal pathology, particularly bowel ischaemia. However, advances in imaging have led to the recognition of benign and self-limiting causes. We report the case of a 34-year-old female with longstanding type 1 diabetes mellitus, autonomic dysfunction, and stage 4 chronic kidney disease (CKD), who presented with severe vomiting, abdominal pain, and malaise. CT revealed HPVG without any evidence of bowel compromise or ischaemia. The patient was successfully managed with conservative treatment, including intravenous fluids, antiemetics, and insulin therapy, resulting in rapid clinical improvement and resolution of the HPVG on follow-up imaging. This report underscores the importance of recognising vomiting-induced HPVG as a benign phenomenon and highlights the essential role of careful clinical assessment in avoiding unnecessary surgical interventions.