Pneumatosis Cystoides Esophagi: Case Report Supporting Theory of Submucosal Spread

A patient with lower esophageal stricture developed pneumatosis cystoides esophagi after many years. Proximal to the stricture air had penetrated the submucosa into the deep muscle layers, suggesting that air entering through a mucosal defect proximal to the stricture was driven into deeper layers by high pressures resulting from partial obstruction. Distal to the stricture air cysts were limited to the submucosa suggesting that air had dissected caudally by peristalsis through loose submucosal tissue to the stomach and proximal small intestine.