No ascites is shown in neither Fig.1 nor pelvic cavity. Because small bowel groups (black arrow of Fig.3-Fig.17) are collapsed, or only mildly dilated, it is impossible to track down them and prove closed loop formation. However, because of findings of diminished mural contrast-enhancement in comparison with uninvolved small bowel (SB), significant stranding (black arrowhead) of mesentery in Fig.4 and Fig.5, venous engorgement (white arrowhead of Fig.6-Fig.8) and gasless mildly distended small bowels, strangulated small bowel obstruction. cannot be ruled out. Based on these findings, laparotomy was performed. In central area of small intestine, 140cm length was constricted and formed closed loop by an adhesive band. Strangulated loops of bowel were congested but viable (Fig.A: intraoperative image) and no resection was needed. Strangulated obstruction without distension like this case is very rare, but should be kept in mind so as not to delay a diagnosis.

Reference case: A 76-year-old male with a history of esophagectomy for cancer presented with epigastric pain for 6 hours. Temperature: 36.5 degrees Celsius, abdomen showed tenderness over right upper quadrant.
Despite no distension, findings of pleural effusion and ascites (reference mark) in Fig7, small bowel group (black arrows) with poor mural contrast-enhancement in Fig.1-Fig.6, vascular engorgement (white arrowhead of Fig.4 and Fig.5 ) and significant mesenteric stranding (black arrowhead) are highly indicative of strangulation. Surgery revealed strangulated small bowel obstruction caused by an adhesive band, and ischemic finding was immediately improved by lysis of band.