Giant bulla in pneumatosis cystoides intestinalis

In pneumatosis cystoides intestinalis the air sacs are generally small and the mesentery is rarely involved. We describe a 23-year-old woman with mixed connective tissue disease and known esophageal ulcer who developed hematemesis and abdominal distention. Colonoscopy showed pneumatosis coli. A computed tomography (CT) scan showed a 23 cm gas-filled mass, presumably a mesenteric bulla. A conservative approach was elected and the patient's gastrointestinal symptoms improved though there was no change in the size of the bulla 3 weeks later.