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. 2023 Mar 18;48(6):2167–2195. doi: 10.1007/s00261-023-03877-2

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© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

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Fig. 11 — a A 59-year-old male patient with known metastatic gastric cancer presented with signs and symptoms of shock. Axial plane postcontrast CT images showed multiple dilated small bowel loops (asterisks) with no sign of abrupt transition point suggestive of mechanical obstruction. In addition, there were some small bowel segments with no appreciable wall (arrowheads) suggestive of mural necrosis. Emergent surgery confirmed long-segment small bowel necrosis. b A 77-year-old female patient with a history of colon cancer presented to ER with findings suggestive of metabolic shock. Coronal plane postcontrast abdominal CT image showed dilated bowel loops (asterisks), widespread pneumatosis intestinalis (arrowheads), and air bubbles within intrahepatic portal vein branches (arrows). Imaging findings were found to be suggestive of extensive transmural intestinal infarction. Surgery confirmed almost complete necrosis of the small bowel segments. c A 62-year-old male patient presented with acute kidney injury, diffuse abdominal pain, and hypotension. Non-enhanced abdominal CT showed pneumatosis intestinalis, air densities within the mesenteric veins, and intrahepatic portal vein branches suggestive of transmural bowel necrosis. Coronal plane minimum-intensity projection CT image better demonstrated the air within distal mesenteric veins (asterisk). Also noted were air densities within the superior mesenteric vein and intrahepatic portal vein branches (arrows). Surgery confirmed intestinal necrosis