Hepatic portal venous gas (HPVG) is very rare; it is associated with multiple gastrointestinal etiologies, with pathophysiology not yet fully understood. It is characteristically fast-progressing and has a high mortality rate. Treatment choice depends on the etiology, including conservative and surgical management.We report an adult patient (less than 25 years old) of HPVG combined with acute upper gastrointestinal hemorrhage, in which massive gas in the hepatic portal vein system by computed tomography of the abdomen was rapidly dissipated by nasogastric decompression conservative management.Nasogastric decompression can be an effective treatment approach for HPVG when timely surgical treatment is not required.Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.