Hepatic portal venous gas (HPVG) is a critical imaging finding, often indicative of an acute abdominal catastrophe of gastrointestinal origin. The condition progresses rapidly and is associated with an extremely high mortality rate. Conventional conservative management or surgical intervention carries significant risk, particularly for perioperative patients.

A 64-year-old female patient was admitted to our hospital on August 1, 2023, with a chief complaint of abdominal pain, distension, and cessation of defecation and flatus for one day. The diagnosis was small bowel obstruction, for which an endoscopic nasojejunal feeding tube placement was performed. On August 30, a follow-up abdominal CT scan revealed intrahepatic biliary duct dilation and HPVG. Due to clinical deterioration, the patient was transferred to the ICU. Following a multidisciplinary consultation, an ultrasound-guided portal vein puncture and catheterization was performed first. This intervention successfully alleviated the signs of HPVG, thereby reducing the risk for the subsequent laparotomy. The patient was ultimately successfully treated.

In this case, the hepatic portal vein was directly punctured under ultrasound guidance, and a PICC catheter was inserted into the portal vein. A mixture of blood and gas was successfully aspirated post-puncture. An immediate post-procedural scan revealed a significant reduction of gas within the intrahepatic portal veins, alleviating HPVG and mitigating the risk for the subsequent laparotomy. This demonstrates that this method can effectively provide direct relief from HPVG and offers a novel therapeutic approach for the management of similar cases.