Diagnostic Value of Iodine Mapping Photon-Counting Computed Tomography (PCCT) in Early Small Bowel Ischemia Caused by a Rare Uterine Fibrotic Band

Background: Small bowel ischemia remains difficult to diagnose early, especially when caused by extrinsic mechanical compression rather than vascular occlusion. Photon counting Computed Tomography (PCCT) allows iodine-based perfusion assessment with significantly improved spectral resolution. Case presentation: A 55-year-old woman with multiple comorbidities presented with acute severe lower abdominal pain and vomiting. Conventional imaging revealed a closed-loop small bowel obstruction without definitive evidence of ischemia. PCCT iodine mapping demonstrated a sharply demarcated segment of absent iodine enhancement in a distal ileal loop, indicating loss of perfusion in that segment. Urgent exploratory laparotomy identified a dense fibrous uterine band causing complete obstruction and an ischemic 40 cm ileal loop, which required resection with primary anastomosis. Conclusion: PCCT iodine mapping enabled early identification of bowel ischemia when standard CT was nondiagnostic. This case highlights PCCT’s growing value in emergency abdominal imaging.