Introduction: Gas in the hepatic portal venous system (HPVS) is a radiological sign that was first described by Wolfe and Evans in infants with necrotizing enterocolitis. This condition is life-threatening and is mostly associated with intestinal necrosis, ulcerative colitis, intraabdominal abscess, and intestinal obstruction. We present the case of a 65-year-old male with a history of chronic renal disease, systemic arterial hypertension, vascular accesses, and arteriovenous fistula (AVF). Chronic consumption of non-steroidal anti-inflammatory drugs (NSAID). Presented to ER department with abdominal pain associated with food ingestion, nausea, and vomiting, presenting hematemesis on 3 occasions. Blood test with sever metabolic acidosis. CT scan showed gas in the HPVS and an extended bowel pneumatosis. The patient presents rapid hemodynamic and neurological deterioration suffering cardiac arrest. The patient was declared dead after unsuccessful CPR was given. Keywords: Portal vein gas embolism, intestinal ischemia.