Intestinal dilatation in the context of acute abdomen: a practical guide to its interpretation on CT

Small bowel obstruction is a common cause of acute abdomen that requires urgent evaluation and often surgical treatment. Computed tomography plays a key role not only in confirming the diagnosis but also in determining its location, underlying cause, and potential complications. This article reviews the essential tomographic findings in acute small bowel obstruction, with particular emphasis on the assessment of bowel wall thickening, contrast enhancement patterns, and both endoluminal and extraintestinal contents. The etiologies are classified into mechanical causes luminal, mural, and extrinsic. Major conditions include intussusception, Crohn’s disease, mesenteric ischemia, neoplasms, adhesions, hernias, and endometriosis, as well as functional causes such as adynamic ileus. The article also highlights warning signs suggestive of severe complications, such as necrosis, perforation, or ischemia, thus enabling timely therapeutic decision-making. In conclusion, accurate interpretation of CT findings by the radiologist is essential to guide clinical management and improve patient outcomes.