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Hepatic portal venous gas (HPVG) is a potentially fatal condition. If vital signs are normal and laboratory data are not suggestive of any necrotic changes, a follow-up computed tomography after a conservative procedure can be performed at short intervals to conservatively monitor the patient.For small lesions, conservative management including local wound care, debridement, and adjustment of renal replacement therapy may suffice. Consulting palliative care is encouraged to help establish goals of care among patient, family, and medical