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Review of the x-ray reveals a great deal of gas and fluid in the large bowel down until the sigmoid. There is no distension of the small bowel. There is no air, nor contents in the rectum. At first glance, one might suspect obstruction at the level of the sigmoid.
The patient was referred to hospital and, initially, a diagnosis of sigmoid volvulus was made. However, CT revealed the symptoms were actually the result of incarcerated inguinal hernia. Acknowledgment: Scott Fields, MD, was the radiologist on this case, which was presented by Nahum Kovalski, BSc, MDCM.
Clinical Challenge: October, 2007
Nahum Kovalski, BSc, MDCM
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