A 62-year-old male presents with a painful, non-reducible bulge in his right groin that appeared 6 hours ago. He now complains of crampy abdominal pain and vomiting. Examination reveals an exquisite, tender, tense, erythematous swelling in the right inguinal region with absent cough impulse. What is the diagnosis and appropriate surgical management?

Answer and explanation

Correct answer: D. Strangulated inguinal hernia; emergent surgical repair without manual taxis

  1. Step 1: A tender, tense, non-reducible hernia with overlying skin erythema and signs of bowel obstruction is a Strangulated Hernia.
  2. Step 2: Manual taxis (forceful manual reduction) is strictly contraindicated because reducing necrotic or gangrenous bowel into the peritoneal cavity can cause acute perforation, catastrophic fecal peritonitis, and septic shock.
  3. Step 3: Immediate emergency surgical exploration and hernia repair (with resection of non-viable bowel if needed) is mandatory.
Answer
Strangulated inguinal hernia; emergent surgical repair without manual taxis.
Why not the others: 'Manual forceful reduction' risks pushing gangrenous, perforated bowel back into the peritoneal cavity; 'Acute epididymitis' presents with testicular pain relieved by elevation (Prehn sign); 'Inguinal lymphadenitis' does not cause bowel obstruction.

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