Presentation
Abdominal pain and distension.
Patient Data
Nonobstructive bowel gas pattern. No opaque calculi or masses. Increased density left flank with centralized bowel loops suggestive of ascites.
Large volume ascites with fluid tracking into both inguinal canals and scrotal sacs. Large right inguinal hernia containing ascites, terminal ileum, caecum, and appendix without obstruction or signs of bowel ischaemia. The hernia is indirect because the inferior epigastric artery is displaced medially. Layering hyperdense material within the gallbladder, vicarious contrast excretion versus sludge. No acute cholecystitis. Splenomegaly. Calcified vas deferens.
Case Discussion
Good example of ascites evident on plain radiographs and confirmed on CT. Also a good example of medial displacement of the inferior epigastric artery due to an indirect inguinal hernia. The calcified vas deferens can be traced into the hernia sac.
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