An unstable lump in the groin

A 49 year old man with type 2 diabetes presented with a three day history of severe right sided groin swelling and pain, feeling generally unwell, fatigue, and fever. His medical history included two myocardial infarctions (11 and 16 years earlier) and a previous right sided inguinal abscess (two years earlier) that healed after incision and drainage. A 20×10 cm lump and skin crepitations were felt in the right groin. Overlying skin appeared healthy with no evidence of erythema, necrosis, or pallor. Glasgow coma scale (GCS) was 15, blood pressure 85/64 mm Hg, heart rate 114 beats/min, temperature 38.4°C, oxygen saturations 98% on room air, and respiratory rate 28 breaths …