Ischemic gut

Abdominal aortic luminal narrowing secondary to mural thrombosis including severe stenosis at the origin of the celiac trunk and SMA where there is very poor/no opacification (indicating near or total occlusion) of these vessels. Extensive calcification along their path. The inferior mesenteric artery is not well seen.

Stomach and small bowel wall is non-enhancing with areas of pneumatosis intestinalis especially in the distal jejunum and ileum without obvious dilated with multiple air fluid levels. No free gas or free fluid.

Liver and spleen are hypoenhancing. Adrenal glands are hyperenhancing. Kidneys are atrophic with bilateral striated nephrograms. They both demonstrate multiple simple appearing cysts. Left renal pelvis calculus.

Bilateral pleural effusions, larger on the right. Dependent pulmonary atelectasis in both lung bases.

False aneurysm at the aortic bifurcations extending down both common iliac arteries and into the internal iliac arteries both of which do not opacify, with an aneurysm of the left. Extensive reflux of contrast down the IVC to the level of the femoral veins.

Conclusion:

Findings are consistent with bowel ischemia (and almost certainly areas of extensive infarction of small bowel given that there are areas of pneumoatosis) with evidence of severe hypotension. There may also be a degree of liver and spleen hypoperfusion. No perforation at this stage. Proximal SMA thrombosis noted, this being the likely underlying cause.