Patient is a newborn with abdominal distention. Abdominal ra | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Patient is a newborn with abdominal distention. Abdominal radiograph shows a dilated air-filled loop of small bowel extending into the left hemiscrotum. Inguinal hernias are one of the most common causes of small bowel hernias in children. #TummyTuesday

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55 y.o. male with h/o hernia treated with mesh 10 years ago. Over the last few months he has been complaining of progressive pain in the area, eventually developing a fistula from the small bowel to the anterior abdominal wall. The picture shows an en-block resection of a segment of small bowel (opened, arrow in its lumen) and surrounding soft tissue of the abdominal wall. What perforated the small bowel causing the fistula?

Images from an MR enterography and a small bowel followthrough show a sack surrounding an ovoid collection of small bowel (arrow). Paraduodenal hernias are internal hernias. Left-sided hernias are more common and occur when bowel herniates through a defect called Landzert's fossa behind the fourth portion of the duodenum. #TummyTuesday #HM15

Radiograph of the abdomen obtained during small bowel follow through shows the appendix (arrow) extending into the inguinal canal consistent with an Amyand hernia. An Amyand hernia represents an inguinal hernia containing the appendix. This occurs in approximately one percent of inguinal hernias.

The first thing I look at on an abdominal x-ray is the bowel, and specifically whether the loops visible are small or large bowel, and how dilated they are. The small bowel has rings or lines running across the whole width known as the valvulae conniventes. Large bowel haustral folds typically do not run all the way across the width. Approximate limits of size are 3 cm for small bowel and 6 cm for large bowel, except for the caecum which is 9 cm. This x-ray shows dilated small bowel loops and the CT shows that a hernia is the cause of the obstruction. Image and caption credit: @DrVikasShah

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