title: The appearance of free-air in the abdomen with related pneumatosis cystoides intestinalis: Three case reports and review of the literature.
abstract: BACKGROUND
  Pneumatosis sistoides intestinalis (PSI) is a rare condition with unknown origin, defined as the appearance of gas-filled cysts in the intestinal wall. It usually occurs due to respiratory infections, tumor or collagen disease, traumas, immunosuppression.
  
  
  METHODS
  Three patients with PSI were examined that followed up and treated in our clinic. The first patient was hospitalized for emergency treatment of previously diagnosed free-air under the diaphragm. He had a defense on physical examination and free-air was detected in X-ray and abdomen CT. We decided to laparatomy and peroperatively, stenotic pylorus with an abnormally increased stomach and gas-filled cysts were seen in the terminal ileum. Antrectomy and gastrojejunostomy with partial ileum and cecum resection and end ileostomy were performed. The second patient underwent laparatomy because of intraperitoneal free-air and acute abdomen. Partial ileum and cecum resection and ileotransversostomy were performed. The third patient with intraperitoneal free-air was treated with antibiotics, oxygen treatment and bowel rest.
  
  
  CONCLUSIONS
  PSI is usually asymptomatic. Plain radiographs, USG, CT, upper gastrointestinal endoscopy, colonoscopy can use for diagnosis. Treatment of PSI depends on the underlying cause; include elemental diet, antibiotics, steroids, hyperbaric oxygen therapy and surgery.
  
  
  CONCLUSIONS
  In patients with asymptomatic and symptomatic PSI are different treat. Symptomatic PSI can be safely treated antrectomy and gastrojejunostomy with partial ileum and cecum resection.
authors.affiliation: Kars State Hospital Department of General Surgery, Turkey. Electronic address: mhmtaziret@gmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aziret
authors.affiliation: Adana Training and Research Hospital Department of General Surgery, Adana, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Erdem
authors.affiliation: Kars State Hospital Department of Pathology, Kars, Turkey.
authors.forename: Yiğit
authors.initials: Y
authors.lastname: Ülgen
authors.affiliation: Kars State Hospital Department of General Surgery, Turkey.
authors.forename: Şahin
authors.initials: Ş
authors.lastname: Kahramanca
authors.affiliation: Adana Training and Research Hospital Department of General Surgery, Adana, Turkey.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Çetinkünar
authors.affiliation: Adana Training and Research Hospital Department of General Surgery, Adana, Turkey.
authors.forename: Hilmi
authors.initials: H
authors.lastname: Bozkurt
authors.affiliation: Namık Kemal University Department of General Surgery, Tekirdağ Turkey.
authors.forename: İlhan
authors.initials: İ
authors.lastname: Bali
authors.affiliation: Adana Training and Research Hospital Department of General Surgery, Adana, Turkey.
authors.forename: Oktay
authors.initials: O
authors.lastname: İrkörücü
keywords: Gas-filled cysts; Pneumatosis sistoides intestinalis; Terminal ileum