Asymptomatic pneumoperitoneum or pneumatosis cystoides intestinalis? Easy to make a mistake

Pneumoperitoneum refers to the presence of intraperitoneal free gas outside the viscera. A perforation of a hollow viscus is the main cause and usually indicates a surgical emergency. However, some case of pneumoperitoneum can be completely asymptomatic and secondary to benign conditions that do not require any surgical intervention. In this situation a misleading diagnosis of pneumoperitoneum may occur. The authors are going to present a case of a 79-year-old man with an asymptomatic pneumoperitoneum incidentally detected by CT-scan and subsequently revealed to be pneumatosis cystoides intestinalis (PCI) at diagnostic laparoscopy. PCI is a rare condition characterized by the presence of gas-filled cyst in the submucosa/subserosa of the bowel wall that can easily mimic pneumoperitoneum on radiological imaging. A thorough examination of radiological findings is crucial in preventing unnecessary surgical procedures that may expose patients to potential associated morbidities.