- The patient presented with a 2 year history of a gradually enlarging swelling in the right groin region that increases with straining and lifting but reduces spontaneously when lying down. On examination, a 10x2cm swelling was found in the right inguinal region extending into the scrotum that was reducible on manual reduction. Based on the history and examination findings, it appears the patient has an indirect inguinal hernia in the right groin.

2. Mr. X
45 years
Male
Rajagram, Bankura
Manual Labourer
Hindu
26th April 2020, Surgery
Ward

3. Dragging sensation in the Right Groin
Gradual onset progressive Swelling in the Right
Groin
Dull aching pain over the swelling.
2.5
years
2 years
1 week

4. •Patient was apparently well two and a half years
back.
•Gradual onset dragging sensation in the Right Groin
2 years back that was followed by a small Swelling in
the same groin that he noticed 6 months later.
•The swelling has been enlarging ever since, to attain
its present size and presently it has extended to his
Right Scrotum.
•The swelling initially disappeared automatically
when he lied down, but over the last year it had to be
manually pushed back inside his abdomen.

5. •It aggravated when he lifted heavy weights or coughed
and strained.
•There is no history of urinary difficulty, chronic cough but
he suffers from chronic constipation and passage of hard
stools.
•Over the last week has developed an occaisional dull
aching pain and a sensation of heaviness over the
swelling, that vaguely radiates to the centre of the
abdomen for which he seeked medical aid.
• However, there was no complaint of vomiting,
abdominal distention or cessation of passage of stools,
or the swelling being stuck recently.

6. PAST HISTORY
• No History of : COPD /HTN/T2DM/
BA/TB
• History of Right sided Renal Stone
that was treated surgically 4-5 years
back (Pyelolithotomy)
PERSONAL
HISTORY
• Married, Hindu Male
• Poor Socio-economic Status
• Mixed regular non vegetarian diet
• Addicted to smoking bidis
• Sleep patterns are not altered.

7. FAMILY
HISTORY
No History of similar swellings in the
family
TREATMENT
HISTORY
Patient did not seek any medical
aid, prior to this present hospital
admission for the present
complaint.
HISTORY OF
ALLERGY
No Known allergy to drugs and
food

9. • Mental Status- Conscious, alert and Cooperative
• Decubitus of Choice
• Built and Nutrition- Moderately built, BMI- 20
• Karnofsky Performance status - 90
• Pallor , Icterus , Clubbing , Cyanosis, Edema - Absent
• Tongue – Moist
• Temperature- 38 degree Celsius.
• NeckVeins – Not distended
• Neck Glands- Not enlarged
• Pulse- 90/min, Right arm, sitting position, good volume,
normal character and no asynchrony of peripheral pulses.
• Temperature- 110/78 mm of Hg in Sitting Position
• Respiratory Rate – 18 breaths/ min.

10. Inspection

11. • A 10X 2cm pyriform swelling
was observed in the Right
Inguino- scrotal region
• The swelling occupies the
Right Hemiscrotum and
displaces the Penis to the
contralateral side.
• There are no scars,
pigmentation, pressure
marks, over the swelling.The
skin over it is not inflamed.
• There is no visible peristalsis
over the swelling.
• Expansile cough impulse is
present.

12. • The inspectory findings were confirmed on
palpation.Temperature is not raised.
• The swelling lies above the inguinal ligament
and originates medial to the pubic tubercle,
from the root of the scrotum to reach the base
of scrotum.
• Anterior to the cord structures.
• It is not possible to get above the swelling.
• It is well defined, non tender with doughy and
granular consistency
• The swelling can be reduced manually by taxis,
wherein the first part of the swelling reduces
easily.
• Deep ring occlusion test is +
• The testis is felt separate from the swelling,
with a normal testicular sensation.

13. • Inguinal lymph nodes were not
palpable.
• The swelling was dull on
percussion.
• No Peristaltic sounds were heard
on auscultation over the swelling.
Invagination test (painful)
Zieman’s test (low sensitvity)
------------------------------------
NOT DONE
------------------------------------

14. ABDOMEN
• There is a visible, well healed scar of an
old Right Lumbar incision, that
extends from the RenalAngle to the
anterior abdominal wall.There are no
scar related complications.
• Tone of the abdominal muscles is
normal.
• SOFT
• NO HEPATOMEGALY
• NO SPLENOMEGALY
• NORMALTYMPANIC NOTE ON
PERCUSION
• IPS +
• DRE- NORMAL

15. CHEST
[CARDIO-VASCULAR
&
RESPIRATORY]
CENTRAL NERVOUS
SYSTEM
&
SPINE
• CLEAR
• VESICULAR BREATH
SOUNDS
• NORMAL HEART SOUNDS
• NO ADDED SOUNDS
• WITHIN NORMAL
LIMITS

16. • Dragging sensation in the Right Groin for the last 2 and a half years
-> Gradual onset swelling that developed in the Right Groin for the
last 2 years -> Presenting with the swelling in the right groin that
increases with standing, straining or lifting heavy weights and
spontaneously disappears on lying down -> Recent onset dull
aching Pain for 7 days->the swelling needs manual reduction by
the patient -> no urinary symptoms or features suggestive of
bowel obstruction.

17. Local Examination –
Right sided 10X2 cm pyriform inguinoscrotal swelling, above and medial to
the pubic tubercle.The skin over it is not inflamed, it reaches upto the base of
scrotum,lying anterior to the cord stuctures, but separate from the testis. It is
doughy and granular in consistency with an expansile cough impulse. It is
reducible, with the first part of the contents going in easily and the second part
being difficult to reduce. Deep ring occlusion test is positive. Percussion note
over the unreduced swelling is dull and bowel sounds are not audible.
Systemic Examination – All other Systems are apparently Normal.The
Right sided surgical scar in his lumbar region is well healed and correlates
to his history.

18. In a 45 year old male