SummaryThe clinical entity of hepatic portal venous gas has been described. A patient with chronic ulcerative colitis is added to the small number of survivors. This condition is probably more common than reported, and a careful search of the hepatic region in abdominal roentgenograms of all ill patients with distention, intestinal congestion, or infarction may result in a higher frequency of recognition of this clinical sign. These patients are acutely ill, and most die. The exact etiology is still unclear, but present evidence suggests invasion of the mesenteric and portal venous system by gasforming bacteria through a damaged intestinal mucosa. Aggressive antibiotic therapy against these organisms, combined with early surgical removal of vascular compromised bowel, may lead to a better survival rate in these patients.