A 51-year-old woman presents to the emergency department with a painful right groin. She reports lower abdominal distension and has vomited twice on the way to the hospital. She has passed flatus but has not opened her bowels since yesterday. She is otherwise fit and well and is a non-smoker. On examination, Blood pressure is 106/70 mmHg and the pulse rate is 108/min. She is febrile with a temperature of 38.0°C.
The abdomen is tender, particularly in the right iliac fossa, and there is marked lower abdominal distension. A small swelling in the right groin, which is originating below and lateral to the pubic tubercle. The lump is irreducible and no cough impulse is present. Digital rectal examination is unremarkable and bowel sounds are hyperactive. Hemoglobin 14.1 g/dL, WBC Count 18.0 million/L, Platelets 361 million/L What is the cause of the x-ray appearances? What is the initial…
