You are examining a direct inguinal hernia in a 45 year old man. On examination the swelling is doughy in consistency and dull on percussion. The swelling is reducible but reduction is difficult towards the end. What is your diagnosis?
You are already told that it is a case of direct inguinal hernia. So hydrocele is out. In case cystocele the swelling gets enlarged on attempt to micturate and the swelling reduces in size following micturition. Another feature is that pressure on the swelling produces the desire to micturate. Enterocele is elastic in consistency with resonant note. Its reduction is difficult initially and easy downwards the end. Epiplocele is doughy and granular in consistency and has a dull note on percussion. It can be reduced easily in the beginning but is difficult towards the end. Ref: Das, 5th Edition, Page 442.
Cystocele
Enterocele
Epiplocele
Hydrocele