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JAMA Surgery Clinical Challenge
March 2016

Painful Right Inguinal Swelling

Author Affiliations
  • 1Department of Digestive Surgery and Surgical Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France
  • 2Equipe Mixte de Recherche 3738, Ecole Doctorale EDISS 205, Université Claude Bernard Lyon I, Lyon, France
  • 3Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
JAMA Surg. 2016;151(3):285-286. doi:10.1001/jamasurg.2015.2766

A 69-year-old man presented to the emergency department with a 5-day history of painful right inguinal swelling. His medical history included hypertension, peptic duodenal ulcer, and resection of a melanoma of the right foot associated with inguinal lymphadenectomy performed 3 years earlier. He also reported a similar episode of ipsilateral inguinal swelling punctured and diagnosed as seroma 5 months earlier.

Physical examination revealed a right inguinal irreducible swelling that was painful on palpation. The rest of the abdomen was soft and normal except for pain in the right iliac fossa. There was no local inflammatory aspect. Laboratory testing showed normal white blood cell count, slight increase of C-reactive protein level (10 mg/L [to convert to nanomoles per liter, multiply by 9.524]; normal range, 0-5 mg/L) and mild renal impairment (creatinine level, 1.4 mg/dL [to convert to micromoles per liter, multiply by 76.25]; normal range, 40-105 mg/dL). A contrast-enhanced abdominopelvic computed tomography revealed a hypodense mass located at the right groin region, with a targetlike image within it (Figure 1).

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