MedPix Medical Image Database COW - Case of the Week Case Contributor: Michael Krasnokutsky Affiliation: Uniformed Services University

MedPix No: 8211 - History Pt Demographics: Age = 75 y.o. Gender = man 75 year old man presented to emergency room with abdominal pain. Downloaded by (-1)

MedPix No: 8211 - EXAM & LABS WBC normalPhysical exam of the groin area suggested the diagnosis of an inquinal hernia.

Small bowel obstruction secondary to left inguinal hernia Plain radiograph of the abdomen demonstrates dilated stacked loops of small bowel in the left lower quadrant. This is consistent with clinical suspicion of small bowel obstruction. Downloaded by (-1)

Small bowel obstruction secondary to left inguinal hernia Scanogram from abdominal CT done 1 hr after abdomnial radiograph demonstrates interval increase in number of dilated stacked small bowel loops consistent with onbstruction. Downloaded by (-1)

Small bowel obstruction secondary to left inguinal hernia Non contrast CT through the pelvis demonstrates soft tissue mass within the expected area of the inquinal canal. From the information on superior images, this soft tissue mass was confirmed to be bowel. Downloaded by (-1)

Small bowel obstruction secondary to left inguinal hernia Non contrast CT through the pelvis demonstrates a soft tissue mass within the expected area of the inquinal canal. There may be air within the lumen. From the evaluation of the superior images, this soft tissue mass was confirmed to be bowel. Downloaded by (-1)

FINDINGS Plain film: Several dilated stacked loops of small bowel FINDINGS Plain film: Several dilated stacked loops of small bowel.CT scan of the abdomen and pelvis was performed and demonstrates bowel in the inguinal canal - consistent with hernia.

DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis?

Diagnosis: Small bowel obstruction from inguinal hernia Dx Confirmed by: Physical exam and radiological study

DISCUSSION