The patient underwent diagnostic laparoscopy after the initial CT scan which showed a mildly pale and dusky distal ileal loop (100 cm proximal to the ileocecal valve) without any frank evidence of ischemia. Due to the lack of bowel ischemia, the patient was managed conservatively.

5 days later, the patient’s general condition deteriorated (tachycardia, anuria, septic shock, and severe metabolic acidosis). CT scan was repeated which showed small bowel ischemia with bowel obstruction. Exploratory laparotomy was done which showed a one-meter long gangrenous ileal loop 20 cm proximal to the ileocecal junction. The diseased bowel segment was resected with end to end anastomosis. 

Pathological analysis of the resected bowel segment showed mucosal and full-thickness necrosis of the small bowel consistent with bowel ischemia.

Postoperatively, no improvement was seen in metabolic acidosis and 2 days later, she had a cardiac arrest and died.