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Case 128: Worsening pain in the groin

This gentleman presented acutely with a sudden increase in groin pain. He had noticed a slowly enlarging lump in the right groin over the past few months. The pain and size of the lump would decrease at the end of each day as he got home from work, sat down, and relaxed.

1. What is the diagnosis?

From the history, the possibilty of an inguinal hernia would have to be considered likely. The recent increase in pain should be considered to be due to incarceration until proven otherwise.

2. What treatment would you offer this man acutely, if any?

The photo shows a lump in the right hemiscrotum above the right testis. This is the scrotal lump that you cannot 'get above'. On examination, the hernia was indeed not reducible and an urgent open hernia repair was carried out. The incarcerated omentum was oedematous but not ischaemic so mesh was used to repair the defect.

An urgent operation should always be performed in this case. Delay will only compromise the incarcerated contents vasularity and prolong the patients pain.