Intended for healthcare professionals

Endgames Case Review

An unstable lump in the groin

BMJ 2019; 365 doi: (Published 20 June 2019) Cite this as: BMJ 2019;365:l2214
  1. Zain Sheikh, core surgical trainee,
  2. Augustine Akali, consultant plastic and reconstructive surgeon
  1. Department of Plastic Surgery, Hull Royal Infirmary, Hull, UK
  1. Correspondence to Z Sheikh Zain.sheikh{at}

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 …

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