The purpose of the present study was to examine deeply the treatment strategies implemented in four patients diagnosed with pneumatosis cystodes intestinalis and their results. Medical records of four patients who had been treated at the diagnosis of pneumatosis cystoides intestinalis between January 2006 and November 2011 were investigated retrospectively. Three (75%) of the patients were male and 1 (25%) female, with the average age of 47.3±19.3 (21–66) years. Pain in abdomen was the first symptom complained by all four patients on admission. While the findings consistent with the peritonitis were revealed during physical examination in three of the cases, abdominal tenderness was detected in one patient. Of all the cases, 2 were accepted as the primary cases due to unknown etiology, while chronic obstructive pulmonary disease and peptic ulcer were held responsible in the etiology, thus assigning these cases in the secondary pneumatosis cystoides intestinalis group. Plain abdominal x-ray images acquired in all patients revealed subdiaphragmatic free gas collection; moreover, free fluid collection within the abdomen was recognized ultrasonographically in 3 patients. The diagnosis of pneumatosis cystoides intestinalis was established through abdominal computed tomography in the patient followed up under conservative treatment. Mortality and complications occurred in none of the patients. Should the physical examination findings associated with the peritonitis be obscured by subdiafragmatic free gas, such a patient may be erroneously followed up under conservative treatment. Implementation of a surgical strategy should not be deferred in case of acute abdomen.