Suppurative Inguinal Lymphadenitis Mimicking a Strangulated Inguinal Hernia: A Case Report

Abstract

Introduction and Importance: Acute groin swellings are frequently attributed to incarcerated or strangulated inguinal hernias, often prompting urgent surgical exploration. Inguinal lymphadenitis is a less common but clinically important mimicker in emergency settings. This report presents a rare case of suppurative lymphadenitis overlying a reducible inguinal hernia, initially misdiagnosed as a strangulated hernia.

Presentation of Case:

An adult male in his 30s with a year-long history of a stable left inguinal mass presented with three days of worsening pain aggravated by lifting. Examination revealed a firm, tender, non-reducible swelling with no cough impulse. Due to the unavailability of immediate imaging, a clinical diagnosis of strangulated hernia was made, and emergency exploration was performed. Intraoperatively, blood-stained pus and suppurative inguinal lymphadenitis were encountered, with an underlying reducible hernia. Pus culture later confirmed methicillin-resistant Staphylococcus aureus (MRSA). Histopathology demonstrated acute and chronic inflammation without malignancy. The patient improved with appropriate wound care and antibiotics.

Clinical Discussion:

This case demonstrates the diagnostic challenge posed by inguinal lymphadenitis mimicking a strangulated hernia, particularly when imaging is unavailable in resource-limited emergency settings. The intraoperative findings emphasize the need for considering infectious etiologies when groin swellings are irreducible and painful.

Conclusion:

This case highlights the difficulty of preoperatively distinguishing suppurative lymphadenitis from a strangulated hernia. Preoperative imaging, when available, is critical to avoid unnecessary surgical intervention. Surgeons should maintain a broad differential diagnosis in any irreducible inguinal mass.

Keywords: Inguinal lymphadenitis, Strangulated hernia, MRSA, Diagnostic pitfall, Emergency surgery, Case report.