Fig. 18
From: Many faces of acute bowel ischemia: overview of radiologic staging
An 84 y/o female with notable abdominal pain and distension for 1 week and obstipation for 2 days. She underwent CT scan with oral and without IV contrast due to elevated serum creatinine level. a–c Right obturator hernia is seen containing a loop of ileum (thick arrow), causing proximal small bowel obstruction (asterisks). No pneumatosis or pneumoperitoneum was found, so the surgeon decided to make a local inguinal incision to reduce the incarcerated ileal loop; however, this was found to be necrotic (arrow head) (d). A subsequent midline incision for laparotomy revealed a long necrotic ileal segment (dotted arrow), that was resected (e). Retrospectively, the herniated loop showed high mural density (thick arrow) on non-contrast CT examination suggestive of hemorrhagic infarct