Diverticulitis presenting as a strangulated inguinal hernia

Background/Aim: Inguinal hernia is a common diagnosis for patients presenting with a painful groin mass; other potentially dangerous diagnoses may mimic a groin hernia. We present 3 unusual cases of diverticulitis with perforation. The resulting abscess presented clinically as an atypical strangulated inguinal hernia. Methods/Results: From July 1, 1999, to June 30, 2000, 344 patients were admitted to the Johns Hopkins Bayview Medical Center with the diagnosis of diverticulitis. Of these patients, 44 (12.8%) required surgical intervention. We report here 3 cases in that academic year of diverticulitis complicated by perforation and abscess formation that presented as atypical strangulated inguinal hernias. In addition to being rare and difficult to diagnose, such cases illustrate that a tender inguinal mass may not represent a hernia. Conclusions: The diagnosis of strangulated inguinal hernias remains primarily one of clinical suspicion. Radiologic and laboratory studies should augment, not replace, one's clinical diagnosis. In addition, the differential diagnosis of inguinal masses is discussed.