BackgroundPortal venous gas (PVG) is considered a rare finding with a grave prognosis. The most common and critical underlying pathology of PVG is bowel necrosis. However, bowel necrosis is sometimes difficult to properly diagnose. We retrospectively analyzed data of patients that contributed to the decision to perform emergency operation and bowel resection.MethodsBetween 2009 and 2019, 25 consecutive adult patients with PVG were retrospectively identified. Patients were divided into the Operation and Non-operation groups. The Operation group was further subdivided into the Bowel resection and Non-resection groups. Clinical, laboratory and radiographic parameters were analyzed.ResultsConservative management was successful for 32% (8/25) of patients (Non-operation group: mortality 0%). Sixty-eight percent (17/25) were surgically managed (Operation group: mortality 35.3%). In the Operation group, 52.9% (9/17) underwent bowel resection (Bowel resection group: mortality 55.6%); however, bowel resection was unnecessary in 47.1% (8/17) of cases (Non-resection group: mortality 12.5%). A univariate analysis revealed significant differences in GCS, APACHE II, abdominal distention, CRP, lactate, and CT findings of dilatation of bowel, pneumatosis intestinalis, and attenuation of contrast effect of the bowel wall between the Operation and Non-operation groups. However, there were no significant differences between the Bowel resection and Non-resection groups, with the exception of GCS.ConclusionsClinical, laboratory and radiographic parameters can inform decisions on conservative management. However, 47.1% of patients who underwent surgery for suspected bowel necrosis did not require bowel resection, suggesting that this approach alone may not be sufficient to avoid non-therapeutic laparotomy. A new approach should therefore be developed to improve this situation.