Pneumatosis cystoides intestinalis represents multiple noncommunicating, thin-walled gas-filled cysts within the wall of the intestines. It may appear as curvilinear, linear or round collections of air which can range in size from several mm to greater than 1 cm in size. It occurs when there has been damage of the bowel mucosa and passage of gas into the wall produced by bacterial superinfection. Primary pneumatosis occurs in 15% of cases and has no identifiable cause. Secondary pneumatosis accounts for 85% of cases with varied etiologies. The more common etiologies are COPD, intestinal obstruction, intestinal ischemia, and infection. It is seen more commonly in the large colon involving the mesenteric side of the bowel wall. All wall layers may be affected, with the most common being the subserosal and submucosal layers. Associated findings include pneumoperitoneum and gas within the portal and mesenteric vessels. The presence of which does not always indicate poor prognosis. The prognosis varies widely from spontaneous resolution to a fatal outcome depending largely upon the etiology.