Pneumatosis coli causing pneumoperitoneum

This is a case of a 54-year-old gentleman who presented to an outside hospital emergency department with lower abdominal pain. Computed tomography imaging showed a small amount of intraperitoneal free air and cystic pneumatosis coli. He was admitted, managed conservatively with intravenous antibiotics, and then discharged home after his symptoms improved. Elective laparoscopic sigmoid colectomy was subsequently performed with intraoperative findings of partial sigmoid volvulus and extensive pneumatosis coli of the sigmoid colon. Pneumoperitoneum was determined to be from ruptured intramural cysts. The etiology of pneumatosis coli was likely from chronic sigmoid volvulus.