Despite timing for a portal venous phase study, the images are relatively arterial, reflecting a poor cardiac output.
There is a large pneumoperitoneum and gas in the wall of the entire small bowel. The large bowel contains fluid but no gas in its wall. Gas is also present within the mesenteric veins and extends into the hepatic portal veins.
Patchy enhancement of the liver and spleen may reflect infarcts.
There are tight stenoses at the origins of the coeliac axis and superior mesenteric arteries. A short occlusion of the SMA is also present with very narrow calibre branches beyond the occluded segment.
The inferior vena cava is flat and the adrenals are hyper-enhancing, consistent with shock.