An 84-year-old Latino man presented to the emergency department with a recent 3-day history of pain over a preexisting left inguinal hernia, which had been present for the past 5 years. The patient had been obstipated for 3 days but denied any other obstructive symptoms. On examination, his vital signs were stable and he had a soft, nondistended, nontender abdomen. There was an irreducible left inguinal bulge and a 15-cm mass in his left scrotum, both of which were tender to palpation. There were no overlying skin changes. Laboratory studies revealed leukocytosis (white blood cell count, 13 800/μL, with 85% neutrophils). A computed tomography scan was performed (Figure 1and Figure 2).
Computed tomography scan of the left scrotum shows a large structure with an air-fluid level.
Computed tomography scan of the left scrotum using lung windows to illustrate the air-filled compartments.
A. Scrotal abscess
B. Testicular torsion
C. Amyand hernia
D. Perforated diverticulitis
Sun B, Moazzez A, Mason RJ. Image of the Month—Quiz Case. Arch Surg. 2009;144(11):1085. doi:10.1001/archsurg.2009.186-a