A 68-year-old male with a history of bilateral inguinal hernias presents with acute severe groin pain and vomiting. Examination reveals a tense, tender, irreducible swelling in the right groin with overlying erythema. What surgical emergency does this represent?
Answer and explanation
Correct answer: B. Strangulated inguinal hernia
- Step 1: An irreducible, acutely tender hernia with systemic signs or overlying skin changes indicates strangulation with vascular compromise of the herniated bowel loop.
- Step 2: This requires urgent surgical exploration to relieve the obstruction and resect non-viable ischemic bowel.
Answer
Strangulated inguinal hernia.
Why not the others: 'Direct inguinal hernia without incarceration' is typically easily reducible and painless; 'Acute epididymo-orchitis' produces scrotal swelling with intact groin anatomy and pain relief with scrotal elevation (Prehn sign); 'Testicular torsion' presents in adolescents with a high-riding transverse testis.
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