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What is the most likely diagnosis?
Small bowel ischemia probably from a closed loop obstruction.
How could you confirm this with imaging?
Contrast CT would demonstrate non-enhancement of the thick walled bowel.
Would you give oral contrast normally if the clinical question was ischaemic bowel?
No. Intraluminal contrast makes assessment of mural enhancement much more difficult.
Diffuse bowel wall thickening is seen with hypovascular mesentery, as a likely sequela of closed loop obstruction.