Enteritis not SBO due to inguinal hernia

Case contributed by Dr Craig Hacking

Presentation

Abdominal pain and diarrheoa for 4 days.

Patient Data

Age: 72
Gender: Male
Modality: CT

Dilated small bowel demonstrates mucosal oedema, mild mesenteric stranding and prominence of the mesenteric vessels with a comb-like appearance in keeping with hyperaemia. No transition point is identified. The large bowel is unremarkable. There is a small volume of pelvic free fluid in the right and left paracolic pelvis and within the pelvis but no collection or peritoneal free gas.

A right inguinal hernia contains a short loop of distal ileum and fluid, but is remote from the dilated small bowel.

The liver, gallbladder, pancreas, spleen and adrenals are normal in appearance. Multiple bilateral renal cysts noted, the largest in the left lower pole measuring 2.9 cm and the largest in the right lower pole measuring 2.5 cm. The bladder appears normal. Bulky prostate noted.

The imaged lung bases are clear. No suspicious osseous lesions. Degenerative changes noted throughout the lower thoracic and lumbar spine.

Conclusion

Enteritis with mild small bowel dilatation. No evidence of mechanical obstruction despite the presence of a right inguinal hernia containing a small bowel loop.

Case Discussion

The surgeon was able to reduce the hernia easily.

The temptation is to link the dilated small bowel to the inguinal hernia, but the hernia is remote to the loops that are distended.

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Case Information

rID: 37121
Case created: 27th May 2015
Last edited: 23rd Feb 2016
Inclusion in quiz mode: Included

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