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Pneumatosis Cystoides Intestinalis (PCI) is a rare condition that many physicians find challenging to diagnose. PCI is characterized by the presence of gas-filled cysts in the submucosa and serosa of the gastrointestinal system. It can develop due to trauma caused by conditions such as pyloric stenosis, peptic ulcers, ileus and endoscopic procedures. The exact etiology of PCI remains unclear. Treatment is directed towards the underlying cause. Surgical intervention should be considered only after the etiology is clarified or when acute surgical pathologies are detected. In this article, we present a 45-year-old male with a history of peptic ulcer and intermittent abdominal pain for the past 10 years. The patient was referred from an external center with a preliminary diagnosis of hollow organ perforation. During the diagnostic process, PCI and perforation were considered in the differential diagnosis. The patient developed ileus and an acute abdomen during follow-up, which necessitated surgical intervention. [ABSTRACT FROM AUTHOR]