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Pneumatosis cystoides coli is an extremely rare condition with scattered cases reported in the literature. The etiology is largely unknown though hypothesized to be bacterial, pulmonary, or mechanical in origin. Management options depend on the clinical presentation. Surgical intervention is typically reserved for those who ultimately fail conservative management or present in a more urgent or emergent manner.
A 30-year old healthy Ashkenazi Jewish white male presented with intermittent left upper quadrant pain and cramping for the better part of a year. Pain was reported to last from several hours to days and was not associated with diet, bowel function, or activity. Physical examination was unremarkable. Computed tomography of the abdomen and pelvis revealed pneumatosis of the left colon with associated blebs/bullae. Subsequent colonoscopy defined numerous submucosal blebs in his left colon extending to the splenic flexure. Conservative management was instituted consisting of an elemental diet and 3 months of oral Flagyl. Overall symptomology improved and repeat sigmoidoscopic examination demonstrated a decrease in pneumatosis cystoides coli.

CT abd/pelvis images, colonosopcy findings