Richter's Hernia

Another Lump

Step 1: View clinicals

An 80 year old woman presents with a painful and tender lump in her left groin for 2 days. She is otherwise asymptomatic, and cannot recall noticing a lump in the same area prior to this. Her only comorbidity is essential hypertension, which is well controlled via diet alone.

Step 2: Order all relevant investigations

Ultrasound - Left Groin

The ultrasound scan shows a smoothly marginated, uniformly echogenic, doughnut shaped structure surrounded by fluid in the left groin.

Complete Blood Count

WBC/DC: 7,000/mm3 (4,500-11,000) Neutrophils: 70% Lymphocytes: 28% Hb: 14.1 g/dL (11.5-18.0) Platelets: 248,000/mm3 (150,000-400,000)

CT Abdomen

You realize that CT imaging of the abdomen is probably not necessary here.

Doppler - Left Lower Limb

The Doppler scan of the left lower limb shows a normal arterial and venous system, with no evidence of aneurysms or varices.

Step 3: Select appropriate management

Manual Reduction
Nil Per Oral
IV Metoclopramide
Urgent Surgery

Score: ★★☆