Pneumatosis cystoides intestinalis (PCI) is a benign and infrequent form of pneumatosis intestinalis that can be associated with the presence of gas in the peritoneal cavity. Pneumoperitoneum usually suggests bowel perforation. However, the patient did not present peritoneal irritation signs or analytical changes that justify an urgent intervention. This is an example of a "benign" form of pneumoperitoneum, caused by the rupture of the cysts to the peritoneal cavity, that does not require surgical treatment.

This condition may be associated with a variety of diseases. This is the case of a bedridden patient with a history of motor neuron disease and polypharmacy, e.g. corticosteroids.

CT imaging is the gold standard technique for the diagnosis. It allows the detection of 'red flag' findings that may suggest an underlying life-threatening pathology. PCI can mimic conditions like intestinal ischemia. The patient had a CT scan that found no evidence of wall thickening, ascites, bowel dilatation, fat stranding, gas in the portal venous system, altered contrast enhancement or linear pneumatosis intestinalis that suggested intestinal ischemia.
 
This patient was treated conservatively. Follow up CT showed resolution of the pneumoperitoneum.

Images courtesy of Dr Marta Rausell and Dr Alberto Cuñat.