RT Journal
A1 Sun B, Moazzez A, Mason RJ
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2009
FD November 16
VO 144
IS 11
SP 1085
OP 1085
DO 10.1001/archsurg.2009.186-a
UL http://dx.doi.org/10.1001/archsurg.2009.186-a
AB 
An 84-year-old Latino man presented to the emergency department with a recent 3-day history of pain over a preexisting left inguinal hernia, which had been present for the past 5 years. The patient had been obstipated for 3 days but denied any other obstructive symptoms. On examination, his vital signs were stable and he had a soft, nondistended, nontender abdomen. There was an irreducible left inguinal bulge and a 15-cm mass in his left scrotum, both of which were tender to palpation. There were no overlying skin changes. Laboratory studies revealed leukocytosis (white blood cell count, 13 800/μL, with 85% neutrophils). A computed tomography scan was performed (Figure 1and Figure 2).