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Answers on p 446.
A 76 year old man was admitted to the surgical ward with a two week history of right iliac fossa pain associated with two days history of high fever (38.6°C) and right inguinoscrotal swelling. There were no associated bowel and/or urological symptoms. He was not diabetic and had a coronary artery bypass graft in 1993. On examination he was slightly confused, dehydrated, and pyrexial. Abdominal examination revealed an ill defined tender lump over right lumbar area along with a tender right inguinoscrotal swelling. There was evidence of cellulitis and spreading lymphangitis over the right groin.
A plain abdominal and chest x film were normal. A full blood count showed a white cell count of 10.6 × 109/l and haemoglobin concentration of 136 g/l. Blood urea concentration was 10.9 mmol/l and serum creatinine 86 mmol/l. Computed tomography was performed next morning.