Pneumoperitoneum Caused by Pneumatosis Cystoides Intestinalis

An 87-year-old woman presented with abdominal pain for one day. Physical examinations disclosed mild low abdominal tenderness, without rebounding pain or muscle guarding. Abdominal computed tomography (CT) scan showed pneumoperitoneum and pneumatosis intestinalis (Fig. 1A, white arrows) over cecum and ascending colon. Under the impression of ischemic bowel disease with bowel perforation, exploratory laparotomy was done. During operation, gas bubbles (white arrow head) and subserosal gas bubbles (white arrow) on the surface of the colon were found (Fig. 1B). Otherwise, there was no evidence of ischemia bowel disease, and hollow organ perforation. Therefore, the diagnosis of pneumatosis cystoides intestinalis was made and the midline lap-