Abstract: It was previously believed that hepatic portal venous gas (HPVG) was an "ominous sign" or "death sign", and once it appeared, the disease progressed rapidly with a high mortality rate which required immediate surgical treatment. However, with the continuous progress of medical technology, researchers have gained a deeper understanding that various causes can lead to HPVG, not all of which required surgical treatment, and the prognosis was not poor. Unfortunately, there is no guideline or consensus on the diagnosis and treatment of HPVG to guide clinical management and standardize diagnostic and therapeutic behaviors. Therefore, the authors review previous literatures with combined clinical diagnosis and treatment experience to conduct profound discussion on the epidemiological features, etiology, pathogenesis, imaging features, treatment strategies, and progno-sis of HPVG, and develop corresponding diagnosis and treatment procedures with the aims to help clinicians to improve diagnostic and therapeutic outcomes and prognosis of patients.