Imaging Case of the Week 129

The following erect and supine abdominal x-rays are from a 91 year old with abdominal pain/distension and associated vomiting. What can you discern on the x-rays?


Supine AXRErect AXR

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The supine abdominal x-ray shows distended jejunal loops, whereas the erect x-ray shows few air fluid levels.

What can also be seen is the presence of bowel loops over the symphysis pubis and the right infrapubic region. This is abnormal and suggests that an inguinal hernia may be the cause of the intestinal obstruction.

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This patient went on to have a CT scan of the abdomen.

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The CT scans showed a direct right-sided inguinal hernia which was not the cause of the small bowel obstruction as there was no constriction or upstream bowel dilatation. CT  showed dilated jejunal loops with no definite transition point.

This patient had multiple other co-morbidities and as such showed improvement following conservative management.

In a patient with bowel obstruction, always make sure to examine the hernial orifices clinically and check for the presence of bowel loops in the inguinal area of a plain x-ray.