Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 9 4 2025 12 05 e35 e35 Nastaran Babajani Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran. Moojan Shabani Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran Faeze salahshour Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran. Hadi Mirfazaelian Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran. Atousa Akhgar Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2025 10 15 2025 10 28 A 72-year-old woman presented to the emergency department with fatigue and epigastric pain. Imaging revealed pneumatosis intestinalis and portomesenteric venous gas (PMVG), ultimately diagnosed as mesenteric infarction. The case highlights PMVG as an urgent radiological sign requiring prompt recognition and surgical consultation in emergency settings. https://fem.tums.ac.ir/index.php/fem/article/view/1670 https://fem.tums.ac.ir/index.php/fem/article/download/1670/537