A 65-year-old male was found to have hepatic portal venous gas (HPVG)
by computed tomogram secondary to ischemic bowel. Despite aggressive s
urgical and antibiotic treatment, the patient died within 12 hours. Po
rtal pyelophlebitis, when identified by air in the portal venous syste
m, is a grave indicator of ischemic bowel with a very high mortality r
ate, except in patients with inflammatory bowel disease.