26th April 2024

A 60-year-old man presents with a three-month history of intermittent, sharp pain in the groin area, which worsens with coughing and lifting heavy objects.

A 60-year-old man presents with a three-month history of intermittent, sharp pain in the groin area, which worsens with coughing and lifting heavy objects. He notes a small bulge in the same area, which seems to disappear when lying down. He has no history of gastrointestinal bleeding, changes in bowel habits, or significant weight loss. On examination, there is a palpable bulge over the inguinal ligament in the right groin that increases in size with coughing and reduces on lying flat.

Which is the most likely diagnosis?