Pneumatosis cystoides intestinalis (PCI) is a rare disease usually occurring in association with a large variety of gastrointestinal (GI) and non GI conditions in the majority of cases, although idiopathic PCI is also known to occur. There are two theories regarding the development of these intramural gas cysts--the mechanical and bacterial theories. PCI usually runs a benign course, although fulminant PCI can be present both in infants and adults. The importance of this condition for the surgeon lies in its early recognition, in order to prevent unnecessary surgical intervention, especially when pneumoperitoneum without clinical evidence of peritonitis is encountered. Oxygen therapy has been shown to lead to regression of PCI, although recurrences have been reported. Elemental diets and antimicrobial agents have provided symptomatic relief in a few reported cases. The association of PCI with a wide variety of conditions leads us to conclude that PCI may not be a disease in itself, but a sequel to these varied conditions.