The supine abdominal x-ray shows dilated small bowel loops located centrally. What is also visible is loop of bowel in the right inguinal canal. Overall findings indicate an obstructed right inguinal hernia.

The patient had bilious vomiting and was admitted under specialist for surgical management.

In a patient with small bowel obstruction, scrutinize the abdominal x-ray for the presence of a cause. Bowel loop seen below the inguinal ligament is abnormal and may indicate an inguinal/femoral/obturator hernia as the cause of small bowel obstruction.