A 79-year-old African American woman with right lower quadrant pain and a palpable right lower quadrant mass was evaluated on 2 prior occasions, once as an outpatient and once in the emergency department. A working diagnosis of a right inguinal hernia was made. On both occasions, the hernia was reduced and managed nonoperatively because of her medical comorbidities. The patient returned to our emergency department with recurrence of symptoms. Initial examination revealed a normal abdomen with a moderate-sized bulge in the right lower quadrant. However, the patient rapidly developed increased abdominal distention, as seen in Figure 1. The intraoperative findings are shown in Figure 2.