Increased unenhanced bowel-wall attenuation: a specific sign of bowel necrosis in closed-loop small-bowel obstruction.

• Increased unenhanced bowel-wall attenuation is the only sign specific for necrosis • Decreased bowel-wall enhancement is not relevant for differentiating reversible ischemia from necrosis • Preoperative knowledge of bowel necrosis is helpful to plan adequate surgery.