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There is some fluid distension of the appendix, although the wall is not particularly thickened. The surrounding fat is inflamed, and most remarkably, the appendix lies within a right side indirect inguinal hernia, along with a substantial volume of fat. It is not clear whether this is primary appendicitis within a hernia sac, or whether the appendiceal changes are part of the hernia incarceration. The right inguinal region is larger than the left.