Non-enhancing bowel dilatation and secondary ileus on CT as a surgical red flag in geriatric patients with atypical presentations

This case highlights three critical aspects in managing geriatric patients with acute abdominal emergencies: The inherent diagnostic limitations posed by atypical presentations in elderly populations, including unreliable history-taking and attenuated physical signs; The insufficient sensitivity of conventional laboratory markers (leukocytosis, NEUT%, PCT, lactate elevation) for detecting intestinal ischemia; The pivotal role of contrast-enhanced computed tomography (CT) in surgical decision-making, particularly the prognostic significance of non-enhancing bowel wall dilatation as a radiographic hallmark of transmural necrosis. Early surgical consultation and protocolized CT interpretation are paramount for optimizing outcomes in this high-risk patient cohort.