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Ischemic necrosis is very often apparent at the time of laparotomy (Figures 9.4 and 9.5). Because of the extent of the intestine involved, the surgeon may be conservative regarding intestinal resection or may opt not to resect any intestine, resulting in residual necrotic tissue or progressive necrosis. Residual necrotic bowel leads to bacterial translocation and often fatal outcomes. In rare cases, the abdomen is managed open, or a second‐look surgery within a few days of the first is planned to reassess bowel integrity [9]. Further resection of compromised bowel is the treatment of choice for ischemic necrosis. If in doubt about perfusion to the intestines, mesenteric vasculature should be palpated to assess for pulses. If pulses are absent, ischemic necrosis is of higher concern.