Hepatic portal venous gas (HPVG), historically associated with bowel ischemia, is now recognized to have diverse causes beyond necrosis. We describe a rare case in an elderly diabetic dialysis patient, where HPVG was initially detected via ultrasound and CT scan. Symptoms included abdominal pain and urinary issues, leading to the diagnosis of emphysematous cystitis. This case underscores the importance of thorough investigation when HPVG is detected, as unusual conditions like emphysematous cystitis can be the underlying cause.
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