A 64-year-old man presented with sharp pain and progressive bulging in his right lower quadrant of the abdomen for three days (Fig. 1). He was smoker and he underwent appendicectomy about 50years ago. There were no visible skin lesions, no paresthesia, and no bowel changes. The bulge increased in size with increased abdominal pressure, it seemed to be caused by abdominal paralysis. The remainder of the physical exam was normal. The patient did not have diabetes mellitus, and neither abdominal computed tomography nor spinal magnetic resonance imaging revealed abnormalities.