Cross sectional imaging can help for the prompt diagnosis of acute intestinal ischemia. However, suggestive radiological signs have to be interpreted with correlation with the clinical and biological status of the patient. We present a case of acute intestinal ischemia of the distal ileum and the right colon observed in an adult patient. Due to his poor clinical status combined to the fact that the lesions seen on CT were considered as restricted, the patient was treated by supportive medication. Unfortunately, this was followed by a fatal outcome.The time delay between the inital CT and the surgery can be a cause of the discrepancy between the CT signs and the pathological findings.