What is the diagnosis for a 67-year-old male patient presenting with left inguinal discomfort, throbbing pain radiating to the left leg, and a groin rash, with a history of surgery (outpatient procedure) 10 years ago?

From the Research

I strongly recommend ordering an ultrasound of the left inguinal area to evaluate for possible mesh displacement from the patient's surgery 10 years ago, and prescribing miconazole cream for the groin rash, as the patient's symptoms could indicate mesh complications or recurrent hernia, and the rash is likely fungal in nature. The patient's symptoms of discomfort in the left inguinal area with throbbing pain radiating down the left leg could indicate mesh complications or recurrent hernia, which the ultrasound will help identify, as supported by the study 1 that demonstrated the accuracy of ultrasound in diagnosing and typing groin hernias. Miconazole cream should be applied to the affected groin area twice daily for 7-14 days until the rash resolves. The patient should be instructed to keep the area clean and dry, changing underwear daily and after sweating, and to avoid tight-fitting clothing that may exacerbate both conditions. If symptoms worsen or don't improve within a week, the patient should return for follow-up. The mesh displacement concern warrants investigation because surgical mesh can sometimes migrate or contract over time, causing pain or recurrence of hernia symptoms, as suggested by the study 2 that found evidence of mesh contraction or folding after implantation. The groin rash is likely fungal in nature (tinea cruris), which thrives in warm, moist environments and responds well to antifungal treatments like miconazole. Key points to consider in the patient's management include:

• The importance of a protocol-driven approach for ultrasound evaluation of the groin, as outlined in the study 3, to ensure an accurate and comprehensive evaluation.
• The potential for mesh complications, such as migration or contraction, to cause pain or recurrence of hernia symptoms, as highlighted in the study 2.
• The need for patient education on proper hygiene and skincare in the affected area to prevent exacerbation of the rash and promote healing. It is essential to prioritize the patient's morbidity, mortality, and quality of life in the management of their condition, and the recommended approach is based on the most recent and highest-quality evidence available, including the studies 3, 1, and 2.