Pneumatosis intestinalis with pneumoperitoneum: Not always a surgical emergency

Pneumatosis intestinalis (PI) and pneumoperitoneum are commonly recognized as severe signs of gastrointestinal diseases that require emergency surgery. However, these symptoms can also be caused by benign conditions. We describe 4 cases of benign PI and pneumoperitoneum that were detected in different clinical situations (accidental discovery in bilan of aortic dissection (case #1), bilateral pulmonary embolism (case #2), overflow diarrhea due to fecal impaction (case #3), and in follow-up postbiliary digestive anastomosis surgery (case #4), which were addressed with exploratory surgery (case #1) or conservative treatment (the remaining cases), with favorable outcomes. Because PI and pneumoperitoneum can be associated with both life-threatening causes and benign conditions, treatment decisions should be based on the correspondence between clinical and paraclinical features, rather than imaging alone.