OBJECTIVE: To assess the clinical significance of portal vein gas (PVG) demonstrated by computed tomography (CT).

DESIGN: Review of medical records.

SETTING: Three network-affiliated hospitals providing both primary community-based and tertiary services.

METHODS: Review of diagnosis, clinical circumstances, and significance of PVG in 7 patients detected by CT during a 3-year period in 3 affiliated hospitals.

RESULTS: Four of 7 patients underwent laparotomy; 1 patient refused surgery. Two patients were treated with intravenous antibiotics only and had uneventful clinical courses. Of the 3 patients who died, 1 refused and 2 underwent laparotomy.

CONCLUSIONS: This series indicates that more sensitive imaging and more widespread use of endoscopic retrograde cholangiopancreatography, colonoscopy, and liver transplantation have changed the clinical presentation of PVG; PVG may be found in various clinical settings that do not mandate laparotomy; and the significance of PVG must be derived from the clinical context of the individual patient.