Images in Clinical Medicine

Inguinal Hernia

David Rosmarin, M.D., and Chen S. Tan, M.D.

N Engl J Med 2006; 355:601August 10, 2006

• Slide

Article

A 68-year-old man with chronic dysuria and increased urinary frequency presented with three weeks of weakness and fever. Physical examination revealed a man with cachexia who had a large, right-sided inguinal hernia that had been enlarging for more than eight years (Panel A). Computed tomography revealed unobstructed bowel within the hernia sac (Panel B, arrows). A urinary tract infection was diagnosed, and the patient received a course of levofloxacin. Given the size of the hernia, surgical repair would have involved multiple sequential procedures with a high risk of intraoperative death. The patient declined surgical intervention.

David Rosmarin, M.D.
Chen S. Tan, M.D.
New York University School of Medicine, New York, NY 10016