Abdominal Radiology

, Volume 43, Issue 12, pp 3227–3232 | Cite as

Bowel obstruction complicated by ischemia: analysis of CT findings

  • Veronica L. CoxEmail author
  • Ali M. Tahvildari
  • Benjamin Johnson
  • Wei Wei
  • R. Brooke Jeffrey



To analyze CT signs of bowel ischemia in patients with surgical bowel obstruction, and thereby improve CT diagnosis in this common clinical scenario. Surgical and histopathological findings were used as the reference standard.


We retrospectively analyzed CT findings in patients brought to surgery for bowel obstruction over 13 years. Etiology of obstruction (adhesion, hernia, etc.) was recorded. Specific CT features of acute mesenteric ischemia (AMI) were analyzed, including bowel wall thickening, mucosal hypoenhancement, and others.


173 cases were eligible for analysis. 21% of cases were positive for bowel ischemia. Volvulus, internal hernia, and closed-loop obstructions showed ischemia rates of 60%, 43%, and 43%; ischemia rate in obstruction from simple adhesion was 21%. Patients with bowel obstruction related to malignancy were never ischemic. Sensitivities and specificities for CT features predicting ischemia were calculated, with wall thickening, hypoenhancement, and pneumatosis showing high specificity for ischemia (86%–100%).


Wall thickening, hypoenhancement, and pneumatosis are highly specific CT signs of ischemia in the setting of obstruction. None of the evaluated CT signs were found to be highly sensitive. Overall frequency of ischemia in surgical bowel obstruction is 21%, and 2–3 times that for complex obstructions (volvulus, closed loop, etc.). Obstructions related to malignancy virtually never become ischemic.

Key words

CT Intestinal obstruction Intestinal ischemia 


Compliance with ethical standards


No funding was obtained for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local institutional review board. This article does not contain any studies with human participants performed by any of the authors. For this type of study formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of RadiologyStanford University Medical CenterStanfordUSA
  3. 3.Department of BiostatisticsUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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