Pneumatosis masquerading as abdominal free air

Pneumatosis cystoides intestinalis is an uncommon disease characterized by submucosal or subserosal collections of gas in the gastrointestinal tract and its peritoneal attachments. The literature suggests that the clinical course of this illness may be benign and self-limited. Clinical manifestations range from nonspecific gastrointestinal complaints to life-threatening complications of intestinal obstruction or pneumoperitoneum. Radiographic evidence of pneumoperitoneum in relatively asymptomatic patients suggests pneumatosis cystoides intestinalis. Correct radiographic diagnosis may avoid unnecessary surgery. In this unusual case, a patient with apparent subdiaphragmatic free air on radiograph was diagnosed as having pneumatosis cystoides intestinalis that involved the submucosa of the stomach and was related only to severe gastric dilatation. The case was managed expectantly, resulting in resolution of all radiographic findings and complete symptomatic recovery.