title: Pneumatosis cystoidis intestinalis presenting as bowel perforation, a rare entity.
abstract: BACKGROUND
  Pneumatosis cystoides intestinalis (PCI) is an uncommon condition. This following article describes a case of primary PCI presenting as acute abdomen due to perforation of a small bowel cyst.
  
  
  METHODS
  This following article describes the case of an 88 year-old woman admitted at the hospital with peritonitis and consequently operated for a presumed bowel ischemia and perforation. However surgical exploration revealed perforated PCI.
  
  
  CONCLUSIONS
  The pathophysiology of secondary PCI is poorly understood. Gas produced by Gas-forming bacteria may enter the mucosal barrier due and consequently this gas accumulates within the bowel wall. Also malnutrition can prevent the digestion of carbohydrates, which leads to increased bacterial fermentation, and production of large volumes of gas leading to distention and ischemia and subsequently the submucosal dissection of gas. Colonoscopy is helpful in excluding other colonic lesions and it shows the submucosal cysts that have a typical dual appearance: multiple white small cysts coupled to a sub-atrophic mucosa or larger cysts (up to 3cm) with a reddened overlying mucosa.
  
  
  CONCLUSIONS
  The treatment unless complicated should be conservative even in the presence of pneumoperitoneum, after excluding complications.
authors.affiliation: Department of General Surgery, CHR Metz-Thionville, Bel-Air hospital, Thionville 57126, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hanna
authors.affiliation: Department of General Surgery, CHU Nord Hospital, Jean Monnet University, Avenue Albert Raimond, 42270 Saint Etienne, France. Electronic address: Radwankassir42@hotmail.Fr.
authors.forename: Radwan
authors.initials: R
authors.lastname: Kassir
authors.affiliation: Department of General Surgery, Archet 2 Hospital, University Hospital of Nice, Nice, France.
authors.forename: Debs
authors.initials: D
authors.lastname: Tarek
authors.affiliation: Department of General Surgery, CHR Metz-Thionville, Bel-Air hospital, Thionville 57126, France.
authors.forename: Bashir
authors.initials: B
authors.lastname: Bassile
authors.affiliation: Department of General Surgery, CHR Metz-Thionville, Bel-Air hospital, Thionville 57126, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Saint-Eve
authors.affiliation: Department of General Surgery, CHR Metz-Thionville, Bel-Air hospital, Thionville 57126, France.
authors.forename: Bachir
authors.initials: B
authors.lastname: Elias
keywords: Abdominal pain; Bowel perforation; Laparotomy; Pneumatosis