When Portal Venous Gas Is Not Catastrophic: Accidental Hydrogen Peroxide Ingestion Managed Conservatively

Accidental ingestion of hydrogen peroxide is uncommon but may lead to alarming clinical and radiological findings. Portal venous gas is traditionally associated with severe intra-abdominal pathology; however, benign etiologies should also be considered. We report the case of a 63-year-old woman who presented with abdominal pain following accidental ingestion of hydrogen peroxide. The estimated concentration was low (likely household preparation ~3%), although the exact volume ingested was uncertain. Computed tomography revealed extensive portal venous gas and duodenal pneumatosis. Arterial blood gas analysis and serum lactate levels were within normal limits, supporting the absence of bowel ischemia. The patient was managed conservatively with supportive care and supplemental oxygen, with complete radiological and clinical resolution. This case highlights the importance of correlating imaging findings with clinical presentation to guide appropriate management and avoid unnecessary invasive interventions.