Ruptured internal iliac artery aneurysm masquerading as an inguinal hernia

Internal iliac artery aneurysms are rare, representing less than 2% of all aneurysms. Nonetheless, the mortality is high at up to 60% when ruptured. Ruptured internal iliac artery aneurysms commonly present with overt abdominal pain and systemic instability. They can also present with symptoms of pelvic organ dysfunction, such as urinary retention or obstipation. This report describes the first case of a ruptured internal iliac artery (IIA) aneurysm masquerading as a reducible inguinal hernia. It was diagnosed on a Computed Tomography scan, which showed a large contained ruptured right IIA aneurysm with extension of haemorrhage through the hernia sac. He underwent an endovascular procedure to exclude the aneurysm that was uncomplicated, and he had an uneventful recovery. It highlights the importance of considering IIA aneurysms as differentials for abdominal masses, groin lumps or vague symptoms of pelvic organ dysfunction. Thorough exploration of the history and careful examination will help flag these diagnoses in our clinical assessment.