Hepatic portal vein gas (HPVG) is a rare and alarming radiographic finding for patients especially those who had intestinal ischemia. Some surgeons may learn it from books, literature and internet while they may not treat it in a real patient. It often indicates a very serious infection which could result in septic shock even death within a very short time, even though the mortality of patients with HPVG went down with the increased use of computed tomography and ultrasound which allows early and highly sensitive detection of such severe illnesses. Here I report a case in which an 84-year-old man was admitted to emergency department for three days of vomiting and two days of abdominal distension after eating an apple who had HPVG associated with intestinal ischemia and acute gastric dilatation and then died of septic shock in a short time. And the pathogenesis of HPVG is not completely clear at present, while three hypotheses may explain the relation between them. Attention must be paid closely to the patient who has HPVG associated with intestinal ischemia, and something must be done because it may indicate a life-threatening acute abdomen.
Keywords: Hepatic portal vein gas (HPVG); acute gastric dilatation; case report; intestinal ischemia.