Exceptional Association of Pneumatosis Cystoides Intestinalis with Ascites Secondary to Gastric Ulcer

Pneumatosis cystoides Intestinalis (PCI) is a rare disease characterized by the presence of gas-filled cysts in the intestinal wall, which can affect the entire digestive tract, with a predilection for the small intestine and colon. It can be primary or secondary, associated with multiple gastrointestinal or other pathologies. Diagnosis can be challenging to establish, and only a combined radiological and endoscopic evaluation ensures proper therapeutic management, often preventing unnecessary emergency surgical interventions. The patients with pneumatosis cystoides intestinalis are usually treated conservatively; the surgical treatment is reserved for complications We report an unusual case of pneumatosis cystoides intestinalis associated with ascites, in a 65 year-old patient who presented with chronic abdominal pain and vomiting. The abdomen CT showed multiple small air cysts in the intestinal wall, ascites, and free abdominal air. Upper gastrointestinal endoscopy showed a gastric ulcer without no evidence of malignancy on histopathological examination, but with the presence of Helicobacter pylori. Ascitic fluid analysis revealed an exudative pattern. The patient was treated with Helicobacter pylori eradication therapy along with proton pump inhibitors. The outcome was favorable with the disappearance of abdominal pain and ascites. An abdominopelvic CT scan performed after 4 months showed complete regression of cystic images and ascites. To date, very few cases of intestinal pneumatosis associated with ascites have been reported.