Portomesenteric venous gas and pneumatosis intestinalis (PI) are rare but important radiographic findings. They are usually discussed separately in the literature and little is known about the clinical importance of their combination in acute bowel ischemia. Abdominal computed tomography (CT) has proven useful for detecting subtle portomesenteric venous gas or PI in the early stages of acute bowel ischemia. Although the CT findings of either portomesenteric venous gas or PI as separate entities are not pathognomonic of bowel infarction, CT evidence of the combination of both these disorders is strongly associated with transmural bowel infarction, especially band-like pneumatosis. We report a case of portomesenteric venous gas combined with band-like pneumatosis, diagnosed based on CT evidence of both findings. We performed an emergency laparotomy for suspected acute bowel ischemia, which was confirmed by the operative findings.