Computed Tomography Evaluation of Small Bowel Ischemia

Early and accurate diagnosis of mesenteric ischemia remains challenging due to the broad spectrum of clinical symptoms and radiological findings. Prompt diagnosis reduces and may allow for interventional radiology treatment opportunities. Computed tomography (CT) is now the first-line imaging tool for investigation of suspected acute or chronic mesenteric ischemia. However, CT has limitations and may over- or undercall mesenteric ischemia. The optimal CT protocol includes a biphasic or triphasic CT with judicious use of “neutral” oral contrast agents. An understanding of the spectrum of CT findings encountered in mesenteric ischemia is pivotal to an early diagnosis. Failure of timely CT and implementation of the optimal CT protocols may result in the patient’s death. Key radiological features vary significantly according to the etiology and severity of mesenteric ischemia. Detailed assessment of the mesenteric vessels, bowel wall thickness, mucosal enhancement patterns, and mesenteric abnormalities are required.