There is no bowel dilatation on this abdominal radiograph but there is displacement of bowel loops from their normal position by a markedly enlarged spleen. The axillary node biospy showed non-Hodgkins lymphoma.

It is often helpful to start on any abdominal radiograph by identifying colon. The scalloped margin is most helpful, along with careful analysis of the contents, which should be a mixture of stool and gas. Non-dilated small bowel is rather non-descript on radiographs, appearing as small pockets of gas, often without identifiable folds. It is important not only to identify each type of bowel, and determine whether any loops are dilated, but also to step back and look at the overall distribution of gas, as in this case. The markedly enlarged spleen has displaced both small and large bowel without causing obstruction.