Case history/examination:
A 22-year-old man complained of sudden and severe abdominal pain while
sleeping and was brought to our hospital via ambulance. He was writhing
in pain during hospital admission, but denied nausea or constipation. A
medical interview revealed no medical or surgical history. A physical
examination revealed a tender flat abdomen with maximal tenderness in
the upper abdomen. Intestinal peristalsis was normal. There was no
rebound tenderness or abdominal rigidity.
A blood test showed an elevated white cell count (12,300/μL) but no
elevated C-reactive protein (0.0 mg/dL). All the other parameters were
normal. A radiograph indicated a soft part shadow, approximately 13 cm
in size, in the genital area (Figure 1). On examining his genital area,
we found a large, irreducible, non-tender right scrotum (Figure 2). He
did not notice it and denied lower abdominal pain. We, therefore,
suspected inguinal hernia. Computed tomography confirmed external
inguinal hernia. Manual delivery was a failure; therefore, emergency
surgery was performed.
Inguinal hernias have a variety of clinical presentations: a painless
bulge in the groin region, scrotum pain, anteromedial hip pain, and
groin or abdomen pain.1 The median patient age for
inguinal hernia in adults is 50–69 years,2 mostly
affecting men, with a few uncommon occurrences in women or young men, as
in our patient. The genital area must therefore be carefully examined in
such clinical presentations. In our patient, a radiograph helped in the
diagnosis of inguinal hernia. We conclude that special attention must be
paid to the genital area on a radiograph for patients presenting with
abdominal pain, as described in the case above.