Clinical Presentation

An irritable infant with bilious vomiting.

An abdominal radiograph demonstrates a large amount of abnormally dilated bowel throughout the abdomen, suspected of being a distal bowel obstruction. Moreover, gas-containing, dilated bowel is seen in the scrotum (arrows), consistent with bilateral herniation of the bowel through the inguinal canals.

Differential Diagnosis

• Mechanical bowel obstruction: In this case, the plain radiographic findings are essentially diagnostic of bilateral inguinal hernias, which are almost certainly the cause of the patient’s obstructive symptoms.

• Malrotation with midgut volvulus: