Abstract
Acute abdomen is always a challenging case presentation in an emergency department. A thorough clinical examination and prompt differential diagnosis and required investigations can save patients from potentially life-threatening conditions. We report the case of a 49-year-old gentleman who presented with a rare presentation of acute lower abdominal pain which initially mimicked renal colic (flank pain and dysuria), later as an upper gastrointestinal bleed manifested by massive hematemesis due to the stomach being pulled down into a giant inguinoscrotal hernia resulting in a gastric perforation. The patient underwent life-saving emergency midline open laparotomy. To our knowledge and as per the literature reviewed, this is an uncommon presentation of an acute lower abdomen pain wherein the gastric perforation due to a giant inguinoscrotal hernia masquerade as renal colic and posed a diagnostic challenge to the treating emergency physician.