A Painful Groin Pseudotumor Mimicked an Incarcerated Hernia

Abstract

Incarcerated inguinal hernia is one of the emergency operations for delay diagnosis may cause serious dreadful effects such as bowel obstruction, bacterial translocation with sepsis, intestinal wall necrosis, bowel perforation, or even death. On the other hand, inflammatory pseudotumors (IPTs) were first described by Brunn, but their cause remains unknown. These benign lesions are common in children and young adults, but they can also occur in elderly adults. An 88-year-old Chinese man was referred to our hospital with a painful mass in his right inguinal region for 3 days. The patient complained about abdominal fullness, poor appetite, and right groin painful and an enlarged lesion in his groin site since five days ago. Physical examination revealed a tender, painful, untouchable, and nonpulsatile mass lesion in the right groin area. Non-specific bowel gas and stool impaction in the KUB. Ultrasound and color Doppler images showed a laminated and well-defined mass on the right inguinal region with a hypoechoic center without blood flow signals and increased peripheral vascularity, which was similar to a bowel loop through the inner ring into the inguinal canal. Computed tomography revealed a soft tissue mass-like lesion in right inguinal area. We performed an emergent exploratory laparotomy under a tentative diagnosis of an incarcerated hernia, but just found a mass in the hernia sac during the operation. Histopathologic examination showed typical findings of the IPT. The patient was followed for 6 months without evidence of local recurrence or distant metastasis. As it is nearly impossible to make a correct judgment prior to operation, surgical resection is usually required for diagnosing IPTs.