CASE 1: A LUMP IN THE GROIN

History

A 51-year-old woman presents to the emergency department with a painful right groin. She also has some lower abdominal distension and has vomited twice on the way to the hospital. She has passed some flatus but has not opened her bowels since yesterday. She is otherwise fit and well and is a non-smoker. She lives with her husband and four children.

Examination

On examination she looks unwell. Her blood pressure is 106/70 mmHg and the pulse rate
is 108/min. She is febrile with a temperature of 38.0°C. The abdomen is tender, particularly
in the right iliac fossa, and there is lower abdominal distension. There is a small
swelling in the right groin which is originating below and lateral to the pubic tubercle.
The lump is irreducible and no cough impulse is present. Digital rectal examination is
unremarkable and bowel sounds are hyperactive.

INVESTIGATIONS

Haemoglobin                 14.1 g/dL                                      11.5–16.0 g/dL

White cell count            18.0×10 9/L                                    4.0–11.0 109/L
Platelets                            361×109/L                                150–400×109/L
Sodium                               133 mmol/L                              135–145 mmol/L
Potassium                        3.3 mmol/L                                   3.5–5.0 mmol/L
Urea                                     6.1 mmol/L                              2.5–6.7 mmmol/L
Creatinine                       63 mol/L                                        44–80 mol/L
Amylase                            75 IU/L                                         0–99 IU/L

Questions
• What is the cause of the X-ray appearances?
• What is the swelling?
• What are the anatomical boundaries?
• What is the initial treatment in this case?
• What is the differential diagnosis for a lump in the groin region?

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Posted in: 100 Cases In Surgery,100 Cases Series - Clinical Scenarios