Computed tomographic imaging findings of bowel ischemia

LEARNING OBJECTIVES: Learning objectives of this paper are to review and to summarize the pathogenesis of bowel ischemia and to describe its clinical, pathological, and radiological manifestations. BACKGROUND: Bowel ischemia is a common disorder produced by several causes, and it shows various clinical presentations connected with an high mortality. With the increase in average life expectancy, bowel ischemia represents one of the most threatening abdominal conditions in elderly patients. In the last decade, computed tomography has tremendously altered the diagnostic approach to bowel ischemia also influencing the therapeutic approach in the current practice. IMAGING FINDINGS: Computed tomographic imaging findings include bowel wall thickening, portal venous gas, intramural pneumatosis, engorgement of mesenteric veins, loss or increase of bowel wall enhancement, and infarction of other abdominal organs. CONCLUSIONS: Bowel ischemia shows a broad spectrum of radiological manifestations, and regardless of the primary causes, it produces similar radiological features. Bowel ischemia may simulate cancer or inflammatory conditions; so it is a mandatory tight integration between radiological and clinical signs.