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A 55-year-old man with a history of Childs B cirrhosis presented with a 2.5-year history of right groin pain and increased urinary frequency with difficulty voiding. On examination, he had a 5 cm × 3 cm palpable and partially reducible right groin mass that extended into the scrotum. He had a leukocytosis with a leukocyte count of 16 400/μL (to convert to ×109/L, multiply by 0.001), his creatinine level was 1.14 mg/dL (to convert to micromoles per liter, multiply by 88.4), and urinalysis showed leukocyturia with cultures that had positive results for Streptococcus viridians. Axial and sagittal (Figure) computed tomography scans with contrast are shown. A renography using mercaptoacetyltriglycine showed a 34% reduction of right renal function.
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A. Sliding hernia
Inguinal hernias are one of the most common surgical diseases and account for up to 28% of all elective surgical cases performed in the United States.1 Because other diseases may mimic this condition, it is important to recognize other pathologies, as treatment may be different. Saphena varix may also present as a “groin bulge,” but it is a dilation of the saphenous vein due to valvular incompetence. Amyand hernia is an inguinal hernia containing the appendix. Therefore, an appendectomy may also be indicated at the time of inguinal hernia repair. Communicating hydrocele is when fluid flows between the scrotum and peritoneal cavity because of a patent processus vaginalis. Sliding hernias occur when a retroperitoneal organ constitutes part of the hernia sac.
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Corresponding Author: Ashkan Moazzez, MD, MPH, Harbor-UCLA Medical Center, 1000 W Carson Street, F10, Torrance, CA 90502 (firstname.lastname@example.org).
Published Online: September 26, 2018. doi:10.1001/jamasurg.2018.3352
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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