Nausea, Vomiting, and Left Groin Mass

Abstract

A 65-year-old obese woman presents to the emergency department with nausea and vomiting for the past day. The frequency of vomiting has increased despite the fact that she has not eaten for the past 12 hours. Over the last few months, she has noticed a painful “lump” in her left groin that protrudes upon straining (i.e., coughing, bowel movements) but quickly disappears after lying down. She reports that the lump reappeared a few days ago but no longer reduces. She has had no bowel movement and no flatus per rectum for the past 24 hours. Her temperature is 37.9 °C, blood pressure 120/80 mmHg, and heart rate 120/min. She appears ill and uncomfortable with dry mucous membranes. Lung sounds are clear bilaterally. Her abdomen is mildly distended. Bowel sounds are high pitched with tinkles and rushes. Her abdomen is non-tender to palpation. There is a 2 × 2 cm mass in the left groin inferior to the inguinal ligament that is very painful to palpation. The overlying skin is slightly erythematous. The bulge is just medial to her femoral pulse, extending toward her thigh compartment. Laboratory studies are significant for white blood count of 14.7 × 10³/μL (normal 4.1–10.9 × 10³/μL).