We present an unusual case of pneumatosis intestinalis and portal venous gas due to massive fecal impaction resulting in ischemic infarction of three separate bowel segments. The patient was taken emergently to the operating room for an exploratory laparotomy with resection and anastomosis of a proximal loop of the jejunum, distal loop of the jejunum, and most of the terminal ileum, with creation of a loop ileostomy. In our review of the literature, there have been only two similar cases of pneumatosis intestinalis/portal venous gas caused by fecal impaction requiring operative intervention.