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Special Feature
June 2013

Image of the Month—Quiz Case

Author Affiliations


Author Affiliations: Department of Surgery, School of Medicine, St Francis Hospital and Medical Center (Dr Nahmias) and Integrated General Surgery Residency (Dr Muddasani), University of Connecticut, and Radiology Residency, Hartford Hospital (Dr Kaplan), Hartford, Connecticut.

JAMA Surg. 2013;148(6):573. doi:10.1001/jamasurg.2013.304a

A 50-year-old white man presented to the emergency department with a chief complaint of worsening right inguinal pain and swelling for 3 days. He denied any past medical or surgical history. His examination revealed that he had a fever and tachycardia; his right groin was edematous with overlying skin erythemic and tender to superficial palpation. Laboratory test results were significant for a white blood cell count of 18 000/μL (to convert to ×109 per liter, multiply by 0.001). Prior to surgical consultation, a computed tomographic scan was performed (Figure 1). In the operating room, a laparoscopic exploration confirmed the diagnosis (Figure 2).

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Figure 1. Computed tomographic scan showing a thickened structure with adjacent infiltrative changes (arrow).

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Figure 2. Laparoscopic intraoperative finding of partial reduction of the appendix.

What Is the Diagnosis?

A.  Incarcerated inguinal hernia

B.  Incarcerated femoral hernia

C.  Fourniere gangrene

D.  Testicular torsion