Pneumatosis Cystoides Intestinalis Discovered During Exploratory Laparotomy

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by gas-filled cysts that develop in the mucosal and submucosal layers of the digestive tract. PCI is typically a benign disease but complications can occur that require surgical intervention. This patient presented to the emergency department with a two-day history of abdominal and back pain. A contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis led to suspicion of free intraperitoneal air potentially due to bowel perforation, and exploratory laparotomy was indicated. Bowel perforation was ruled out during the procedure, but outpouchings of air-filled cysts were found throughout the small bowel's external surface, leading to the diagnosis of PCI. Distinguishing free intraperitoneal air from PCI on imaging presents a challenge to clinicians. Contrast-enhanced abdominal CT is the preferred imaging modality, but PCI remains difficult to diagnose on imaging alone. Spreading awareness of the typical benign nature of PCI alongside the common presentation on imaging may lead to earlier detection, better treatment outcomes, and prevention of unnecessary surgical intervention.