Axial CT image with intravenous and oral contrast through the level of the mid-abdomen demonstrates massive dilatation of the cecum. There is a prominent air-fluid level (white arrow) and multiple locules of air are noted in the dependent portion of the wall consistent with pneumatosis intestinalis (square). However, no extraluminal free air is present to suggest frank perforation and the wall of the cecum continues to enhance uniformly. The associated perihepatic free fluid (circle) is consistent with a high-grade type of intestinal obstruction.