Incidentally Identified Pneumatosis Cystoides Intestinalis in Patients With Gastric Outlet Obstruction From Addis...

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of multiple gas-filled cysts within the submucosal or subserosal layers of the intestinal wall. Although often asymptomatic and detected incidentally, PCI may be associated with significant underlying gastrointestinal or systemic pathology. We report two young adults from Addis Ababa, Ethiopia, who presented with long-standing upper gastrointestinal symptoms, including early satiety, postprandial epigastric pain, reflux, vomiting, and marked weight loss. Clinical, laboratory, and endoscopic evaluations confirmed gastric outlet obstruction (GOO) secondary to chronic duodenal stenosis. Both patients underwent retrocolic gastrojejunostomy with truncal vagotomy and Braun's anastomosis. During surgery, multiple gas-filled cystic lesions consistent with PCI were incidentally identified on the serosal surface of the small intestine. There were no signs of bowel ischemia, perforation, or peritonitis. No bowel resection was performed, and PCI was managed conservatively. Postoperative recovery was uneventful in both cases, with complete symptom resolution and significant weight gain at follow-up. These cases emphasize that PCI may occur secondary to chronic mucosal disruption and increased intraluminal pressure in GOO. Recognition of PCI in this clinical context is essential to guide appropriate management. When incidentally detected in the absence of complications, PCI does not warrant specific surgical intervention. Management should instead focus on addressing the underlying pathology to avoid unnecessary bowel resection.