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Gastric neuroendocrine tumors (gNETs) are uncommon neoplasms arising from enterochromaffin-like (ECL) cells of the gastric mucosa and account for less than 2% of all gastric malignancies.Their clinical presentation varies widely, ranging from incidental indolent polyps to aggressive, disseminated disease. Presentation with portal hypertensive ascites closely mimicking decompensated chronic liver disease (CLD) is exceptionally rare. A 63-year-old postmenopausal woman presented with six months of progressive abdominal distension and was initially evaluated as having decompensated CLD based on a high serum-ascites albumin gradient (SAAG) in ascites. Upper gastrointestinal endoscopy demonstrated a proliferative polypoidal lesion along the lesser curvature of the stomach with high-grade oesophageal varices. Triphasic computed tomography (TPCT) revealed multiple arterially hyperenhancing gastric lesions, retroperitoneal lymphadenopathy, hepatic and splenic deposits, and spleno-portal axis thrombosis, highly suggestive of a gastric neuroendocrine tumor, subsequently confirmed on image-guided biopsy. The patient received therapeutic paracentesis, portal hypertension-directed therapy, nutritional rehabilitation, and geriatric-focused multidisciplinary care. Surgery was deferred in view of comorbidities and functional status; endoscopic surveillance was selected as the preferred management strategy. This case highlights the diagnostic challenge posed by gNETs masquerading as decompensated CLD and underscores the need to consider occult malignancy in elderly patients with unexplained high-SAAG ascites lacking established liver disease risk factors.