Objective: To summarize the clinical features, pathogenesis, diagnosis and treatment as well as prognosis of hepatic portal venous gas (HPVG) associated with pancreatitis.  
Methods: The clinical data of 2 patients admitted and diagnosed as HPVG associated with acute pancreatitis were retrospectively analyzed. The relevant literature was reviewed and discussed.
Results: Case 1 was a male patient, 65 years of age, who was admitted due to abdominal pain for 10 d and then diagnosed as acute biliary pancreatitis. Abdominal CT did not show HPVG on admission. In this patient, the abdominal distension aggravated during the progress of the disease and signs of septic shock appeared one month after admission; abdominal CT reexamination showed HPVG and a large amount of walled-off necrotic debris in the pancreas and peripancreatic region. The patient was discharged on his own request because of progressive deterioration after 3-d conservative treatment, and died one week after discharge. Case 2 was a 70-year old woman who was admitted for severe abdominal pain for 1 d, and presented with septic shock on admission. CT showed pancreatitis with HPVG and scattered gas collections in the retroperitoneal space. Emergency laparoscopic exploration and converted open incision of the pancreatic capsule for decompression plus abdominal drainage were performed. The situation continued to deteriorate and multiple organ dysfunction could not be corrected after operation. The patient was discharged on her own request 4 d after operation and died on the same day. There were 11 cases of HPVG associated with acute pancreatitis reported by previous literature, of whom, the main manifestation was abdominal pain, and diagnosis of the disease was mainly dependent on CT and B ultrasound,  
6 cases died and 5 cases survived.
Conclusion: HPVG associated with acute pancreatitis is a rare condition, but it is always complicated with intestinal ischemia and necrosis, and results in a high mortality rate. Aggressive surgical management should be performed if conservative treatment fails.