Problem:
A 55 y.o. male presents to the clinic with complaints of lower, left sided pain. He states the pain started 2 weeks ago as a mild discomfort but has increased in severity the past 8 hours. He states the pain started as a nagging ache and lower left sided pelvic pain. He states the pain is now a severe, burning pain that increases with movement. He states the left side of his scrotum feels heavy and achy today. On exam, a 4 cm, soft, tender bulge is noted in the left inguinal area. The left testicle is enlarged and tender. The bulge increases in size when the patient coughs.