Ischemic bowel, if not promptly identified, carries high morbidity and mortality.  It may, but not always, occur in the context of a visible vascular thrombosis on CT.

It can be a difficult diagnosis to confidently make. Appearances include:

a. poorly enhancing or non-enhancing bowel wall

b. pneumatosis intestinalis (intramural gas)

c. small bowel feces sign

d. portomesenteric venous gas

e. arterial or venous thrombosis

f. free abdominal fluid or gas

From a practical perspective, as a radiologist:

• always think out of the box
• be politely skeptical of all you are told
• follow your instincts
• finish the business you start: "own" your patient and score the diagnosis for their welfare