Pneumatosis cystoides intestinalis is a rare disease with an acute or subacute clinical
presentation. Here, we present two cases seen at our institution over a 5-year period. The
first patient underwent emergent laparotomy due to abdominal extraluminal free air caused
by ruptured pneumatosis cystoides intestinalis, which may be related to the use of alphaglucosidase
inhibitors. No perforation of the ascending colon was identified during the operation.
Multiple sigmoid pneumocysts mimicking colonic polyposis were found in the second
patient, who underwent sigmoidectomy for excluding colonic malignancy. We emphasize the
importance of correct diagnosis of pneumatosis cystoides intestinalis and optimal management
to prevent unnecessary surgical treatment.