Gas Beyond the Lumen: Gastric Pneumatosis With Portal Venous Gas Following Blunt Abdominal Trauma

Gastric pneumatosis with portal venous gas (PVG) is an unusual finding after blunt trauma, often regarded as an ominous sign of ischemia or perforation. We report the case of a 54-year-old man who sustained a fall and presented with mild abdominal pain. CT revealed gastric pneumatosis and PVG along with a liver injury, while endoscopy showed a 3 × 3 cm fundic ulcer (Forrest IIc). He remained hemodynamically stable, without peritonitis or biochemical evidence of ischemia, and was managed nonoperatively with proton pump inhibitors, antibiotics, and supportive care. He recovered uneventfully, with complete resolution of imaging findings and ulcer healing on follow-up endoscopy. This case highlights that, although rare, trauma-associated gastric pneumatosis with PVG does not invariably mandate surgery, and nonoperative management can be successful in carefully selected, stable patients under close monitoring.