Pneumatosis cystoides intestinalis is an uncommon condition characterised by multiple gas-filled cysts within the small intestine or colonic wall. Clinical manifestations are unspecific and often found in many other abdominal diseases. To avoid unnecessary laparotomy, radiologic and endoscopic findings are essential to be known. The present case associates symptoms highly suspect of neoplasia like weight loss, rectal mass, bloody stools and tenesmus. Treatment of choice is medical. In the absence of an acute abdomen, surgery is only reserved when it is not responsive to medical treatment.