Background: Air in the portal vein is a serious sign, usually caused by enteric necrosis., Methods: The case report presents a 69-year-old male who died shortly after arrival in our department., Results: Abdominal CT scan showed hepatic portal venous gas, and thrombi in the superior mesenteric artery, the coeliac trunk and in the left iliac artery. Autopsy revealed a necrotic stomach but viable small bowel., Interpretation: Differential diagnoses are discussed, and we conclude that the patient most probably died from ischaemic necrosis. In severely ill patients, hepatic portal venous gas is an indication for urgent laparotomy.