Pneumatosis intestinalis (PI) is a condition in which submucosal or subserosal gas cysts are found in the wall of the small or large bowel [
1]. PI may affect any segment of the gastrointestinal tract. The pathogenesis of PI is not understood but many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical and bacterial causes [
2]. Whatever the pathogenesis, gas forming bacteria gain access to the submucosa through breaches in the mucosa and, once inside the bowel wall, gas may spread along the bowel and mesentery to remote sites. In most cases PI is an incidental finding, whereas in others PI is secondary to a wide variety of gastrointestinal and non-gastrointestinal diseases [
3,
4]. The true incidence of PI is not known but it is increasingly reported because of the more frequent use and improvement in imaging modalities. PI can be seen at any age but usually affects patients > 50 years old. PI usually remains asymptomatic in most cases but may clinically present in a benign form or less frequently in fulminant forms, the latter condition being associated with an acute bacterial process, sepsis, and necrosis of the bowel [
1]. Symptoms include abdominal distension, abdominal pain, diarrhea, constipation and flatulence, all symptoms that may lead to an erroneous diagnosis of irritable bowel syndrome [
5]. Complications of PI such as bowel obstruction, volvulus, pneumoperitoneum and hemorrhage occur in about 3% of patients [
1]. Treatment for PI includes antibiotics, elemental diets, surgery and oxygen therapy. Here we report the case of a patient who responded very well to hyperbaric oxygenotherapy.