The inguinal hernia: not always straightforward, not always a hernia

Swelling in the groin may represent much more than an inguinal hernia and an inguinal hernia may be much more complicated than it seems upon superficial consideration. Intraperitoneal or retroperitoneal hemorrhage as well as many other congenital, inflammatory, infectious, or neoplastic processes occurring either locally or at distance from the groin may present in the groin, simulating a hernia, or within an inguinal hernia sac itself. Delayed and spontaneous rupture of the spleen are not rare occurrences. The case discussed, an episode of delayed rupture of the spleen presenting as blood within an inguinal hernia sac, serves to emphasize that following a complete clinical evaluation many entities other than simple inguinal hernia must be considered if a thorough differential diagnosis of a groin mass is to be developed.