26th April 2024

A 43-year-old woman presents with a six-month history of intermittent, dull pain in her lower left abdominal region.

A 43-year-old woman presents with a six-month history of intermittent, dull pain in her lower left abdominal region. She reports that the pain worsens while standing for long periods and improves when lying down. Recently, she has noticed a small, soft bulge in the same area, which becomes more prominent with standing and coughing, and can be gently pressed back. She denies nausea, vomiting, bowel habit changes, or significant weight loss. On examination, a reducible bulge is palpable in the lower left abdominal quadrant, which becomes more noticeable with Valsalva manoeuvre.

Which is the most likely diagnosis?