This elderly woman has SBO, fever, tachycardia and a tense, tender groin swelling with no cough impulse, so she has a strangulated (probably femoral) hernia. She needs urgent surgery through an incision over the hernia (groin exploration), so the bowel can be checked for viability and the hernia repaired. Reduction should not be attempted (B), because putting strangulated bowel back causes generalized peritonitis. FNA has no role, and a midline laparotomy is not the first approach.