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A 69-year-old man presented to the emergency department with a 3-day history of left-sided lower abdominal and groin pain. The pain had begun 36 hours after the patient had undergone colonoscopy, at which time he was found to have extensive diverticular disease. He had undergone polypectomy of a moderately dysplastic tubular adenoma of the sigmoid colon. On measurement of vital signs, he had tachycardia (pulse rate, 110) and hypotension (blood pressure, 95/70 mm Hg) and was febrile (temperature, 100.7°F [38.2°C]). Physical examination revealed erythema and swelling of the left inguinoscrotal region with associated tenderness on palpation. The remainder of his abdomen was generally soft and nontender on palpation. The results of routine laboratory testing were unremarkable except for a creatine kinase level of 387 U per liter (normal range, 0 to 170), an international normalized ratio of 1.4, and a derived fibrinogen level of 6.4 g per liter (normal range, 1.5 to 4.5). A computed tomographic scan of the patient's pelvis is shown here. What is the diagnosis?
Editor's note: We invite our readers to submit their answers at www.nejm.org/mystery. We will publish the diagnosis in the Correspondence section of the November 29, 2007, issue and e-mail it to everyone who submits an answer. All answers must be received by October 17, 2007.
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