Search

A 14-year-old boy presented with a painful swelling topped by a bruise overlying the skin of the right inguinal region without peritonitis. This was the area of impact of bicycle handlebar while riding 6 days ago. On contrast-enhanced CT scan, we found a traumatic abdominal wall hernia (handlebar hernia) near the right deep ring without any solid organ, bowel or urinary bladder injury. Inguinal exploration revealed a defect in transversus abdominis and internal oblique muscle which was repaired and meshplasty was done.Delayed presentation and ignorance towards ‘handlebar sign’ is associated with visceral injury (haematoma/perforation) will incur the risk of rising morbidity and mortality. With CT scan we can assess the abdominal cavity to rule out associated visceral or vascular injury. Surgical repair for restoring disrupted anatomy with or without meshplasty is the preferred approach.

A 53-year-old man presented for a surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT following recent resection of a melanoma of his right leg and metastasis to his right inguinal region. The scan was acquired approximately 60 min after intravenous injection of FDG. The FDG-PET/CT scan demonstrated no FDG uptake in the right inguinal region. However, intense FDG uptake was observed in skeletal muscles, specifically in the left foot (figure 1A) and around the shoulder, bicep and pectoral regions bilaterally (figure 1B,C). Figure 1 18F-fluorodeoxyglucose positron emission tomography showed intense uptake within the left foot (A) and around the shoulder (B), bicep and pectoral regions bilaterally (C). FDG-PET/CT is an integral part of modern-day practice in oncology imaging …

A 23-year-old woman presented with a painless vulval swelling. On physical examination, a soft fluctuant sausage-shaped mass was found, measuring approximately 4 cm, extending from the right inguinal region to the labia majora. Ultrasound revealed a well-defined hypoechoic elongated mass, septated, extending from the superficial inguinal canal to labia majora. Sonographic findings were consistent with the diagnosis of a hydrocele of the canal of Nuck. Surgical exploration revealed an elongated cystic lesion with a total length of 13 cm, mucous component and internal septations. Histopathological examination of the surgical specimen confirmed the suspected diagnosis.

The bottom line The tissue viability nurse refers a 72 year old woman with lower limb venous stasis and a six year history of a non-healing ulcer on her shin (figure⇓) to her general practitioner. The GP refers her to the plastic surgery team, where incisional biopsy of the ulcer confirms squamous cell carcinoma (SCC), consistent with a Marjolin’s ulcer. Further examination shows palpable lymph nodes in the right inguinal region. Marjolin’s ulcer of the right anterolateral leg. The ulcer has an irregular border and base. It had bled intermittently and had increased in size despite compression bandaging Marjolin’s ulcers are tumours that most commonly arise from areas of chronic inflammation or injury and develop over many years.1 They are most common in old burn scars, but they are also seen in traumatic wounds, venous stasis ulcers, pressure sores, …

An older patient presented with a 4-week history of tender lump in the right groin. Appearances were consistent with strangulated inguinal hernia and theatre was arranged. At operation, the lump was found to be an abscess communicating with the abdominal cavity. Alternative diagnosis requiring further operative management was considered but consent was deemed inadequate to proceed. Operation was abandoned and CT examination arranged. CT unexpectedly identified a cholecystocutaneous abscess discharging through the right inguinal region. The patient made good clinical recovery with ongoing drainage of the abscess and did not require any further operative treatment.

A 70-year-old man with a history of end-stage renal disease under regular haemodialysis is presented to the emergency department with intermittent abdominal cramping pain for 1 day. Physical examination revealed an irreducible palpable mass over the right inguinal region. Laboratory and x ray results were not contributory. A CT of the abdomen was performed and disclosed a right inguinal sac with urinary bladder herniation (figure 1). Figure 1 A hernial sac …

A 79 year old woman, who had previously been fit and well, was referred by her general practitioner to the emergency medical unit with a three week history of a swollen right leg. She had previously been treated for possible cellulitis, with no improvement. She had no systemic symptoms and no risk factors for deep vein thrombosis. At initial presentation to the emergency medical unit she was documented as having a “unilateral swollen right leg, with no evidence of cellulitis.” The rest of the examination was normal. Baseline blood tests were normal, except for a positive D-dimer test. The impression was of a deep vein thrombosis, so she was treated with low molecular weight heparin and a Doppler ultrasound scan was booked as an outpatient. The results of the Doppler scan were normal and she was reassured and advised to see her general practitioner if the swelling worsened. She re-presented to the emergency medical unit three months later with persistent swelling of the right leg, which she felt had slowly got worse. On examination, she had a grossly swollen right leg with pitting oedema up to the groin. She also had three large smooth mobile masses in the right inguinal region. Her pre-test probability score for deep vein thrombosis was 3. The results of a repeat Doppler …

Editor,—Lymphatic filariasis is characterised by a wide range of clinical manifestations. In a non-endemic area the diagnosis may be missed unless the index of suspicion is high.Sex Transm Inf 2000;76:321–328 An 18 year old sexually active male presented with a progressively increasing painless nodular swelling in the right inguinal region of 4 months' duration. The patient had an unprotected vaginal contact with a commercial sex worker 6 months earlier. There was no history of genital ulcer or urethral discharge. The general health …