Herniation of bladder, simulating a direct inguinal hernia.

The differential diagnosis of an irreducible inguinal hernia should not present great difficulties, but a case of the condition about to be described was not diagnosed before operation. 0. C., male patient, aged 43, lorry driver by occupation, no serious illness previously. Seven years ago, in I940, he felt a strain in the right groin after lifting his father out of bed; a small lump developed about one month later. This was diagnosed as a right inguinal hernia; it was reduced and the patient fitted with a truss, which he wore to control it, until he was seen in Apgust, I947, with a lump in his right groin which hee could not reduce. rw There was a small firm swelling fixed in the right groin about the size of a bantam's egg; it was painful on pressure and it was concluded that it was a direct inguinal hernia, probably containing omentum. The hernia could not be reduced but as there was no evidence of obstruction the patient was kept under observation until his admission to hospital some days later. September 5, 1947. Operation. Under Pentothal, gas and oxygen anaesthesia, an incision was made over the inguinal canal. The cord was displaced and no indirect hernial sac was found in the cord. Behind the cord at the medial end of the canal a dark mass was observed and an attempt