395.While moving furniture, an 18-year-old teenager experiences excru-
ciating pain in his right groin. A few hours later he also develops pain in the
umbilical region with accompanying nausea. At this point he seeks medical
attention. Examination reveals a bulge midway between the midline and
the anterior superior iliac spine, but superior to the inguinal ligament. On
coughing or straining, the bulge increases and the inguinal pain intensifies.
The bulge courses medially and inferiorly into the upper portion of the
scrotum and cannot be reduced with the finger pressure of the examiner. It
is decided that a medical emergency exists, and the patient is scheduled for
immediate surgery. Nausea and diffuse pain referred to the umbilical region
in this patient most probably are due to which of the following?
a. Compression of the genitofemoral nerve
b. Compression of the ilioinguinal nerve
c. Dilation of the inguinal canal
d. Ischemic necrosis of a loop of small bowel
e. Ischemic necrosis of the cremaster muscle
Abdomen 503