Pneumatosis cystoides intestinalis with free intraperitoneal air: a case report.

Pneumatosis cystoides intestinalis (PCI) is a rare disorder of the medical management and clinical outcome of which largely depend on the severity of its clinical manifestation. A limited number of cases have been reported in the literature although it is suggested that the true incidence of this disorder is higher than observed in clinical practice. This is the case of a 76-year-old woman with a past medical history of Crohn's disease found to have PCI. The patient initially complained of abdominal pain, distention, and weight loss. Chest and abdominal radiographs demonstrated free intraperitoneal air. CT scans revealed characteristic air-filled cysts in the intestinal wall, which established the diagnosis of PCI. Because the patient did not have an acute abdomen or findings requiring emergency laparotomy she was treated nonoperatively with supportive care. Her symptoms resolved gradually over several days. The patient was discharged home in stable condition tolerating a regular diet and was doing well at follow-up. The sole finding of free air with PCI does not mandate exploratory laparotomy.