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

2. MedPix No: History
Pt Demographics: Age = 75 y.o. Gender = man 75 year old man presented to emergency room with abdominal pain.
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3. MedPix No: EXAM & LABS
WBC normalPhysical exam of the groin area suggested the diagnosis of an inquinal hernia.

4. 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.
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5. 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.
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6. 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.
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7. 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.
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8. 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.

9. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis?

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

11. DISCUSSION