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Age: 6 months

Sex: Male

Indication: Abdominal distension

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Case #29


Findings

  • Gaseous distension of multiple loops of small bowel throughout the abdomen with minimal colonic gas
  • Dilated loop of bowel in a left inguinal hernia
  • No convincing pneumatosis or portal venous gas
  • Gastric tube overlies the gastric fundus
  • Coarsening of the interstitium at the lung bases
  • Mild periosteal reaction along the right greater than left proximal femurs


Diagnosis

  • Incarcerated inguinal hernia

Sample Report

Gaseous distension of multiple loops of small bowel throughout the abdomen with minimal colonic gas and a dilated loop of bowel in a left inguinal hernia. Findings raise concern for small bowel obstruction. Correlate with clinical signs of hernia incarceration.

No convincing pneumatosis or portal venous gas.

Gastric tube overlies the gastric fundus.

Coarsening of the interstitium at the lung bases, likely reflecting chronic lung changes.

Nonspecific mild periosteal reaction along the right greater than left proximal femurs. If there is focal tenderness, recommend dedicated femur radiographs for further evaluation.


Discussion

  • Inguinal hernias are an important cause of bowel obstruction in children, in part because the surgical management is more straightforward than many other causes
  • Always look for gas below the inguinal ligaments, as depicted in the annotated image below


Images

Red arrow: dilated bowel loop in a left inguinal hernia.

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