Materiały źródłowe

• #1 Classification, clinical features, and diagnosis of inguinal and femoral hernias in adults – UpToDate

  https://www.uptodate.com/contents/classification-clinical-features-and-diagnosis-of-inguinal-and-femoral-hernias-in-adults

  Classification, clinical features, and diagnosis of inguinal and femoral hernias in adults […] The epidemiology, pathogenesis, classification, clinical features, and diagnosis of inguinal and femoral hernias will be reviewed. […] The lifetime prevalence of groin hernias is estimated to be 27 to 43 percent in males and 3 to 6 percent in females. […] Groin hernias are the most common surgical condition encountered by primary care clinicians, with 1.6 million diagnosed annually and 500,000 undergoing operative repair in the United States. […] Worldwide, 20 million groin hernia repairs are performed annually, and inguinal hernia repair is the most common of all abdominal wall hernia operations. […] The diagnosis of inguinal and femoral hernias will be reviewed.

• #2 Inguinal Hernia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513332/

  Inguinal hernia repair is an extremely common operation performed by surgeons. More than 800,000 repairs performed annually. Most patients present with a bulge or pain in the groin. Healthcare professionals recommend repairing all symptomatic hernias to avoid complications. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. Most inguinal hernias are diagnosed with a thorough history and physical examination. When history strongly suggests a hernia, but none can be elicited on an exam or in situations where body habitus makes physical examination limited, then a radiologic investigation may be warranted. Radiologic modalities include ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). An ultrasound can detect an inguinal hernia with a sensitivity of 86% and a specificity of 77%. CT scan can detect inguinal hernias with a sensitivity of 80% and specificity of 65%. MRI has a sensitivity of 95% and specificity of 96% in the detection of an inguinal hernia. Surgical repair is the definitive treatment for an inguinal hernia. As a general rule, all symptomatic inguinal hernias should be repaired when possible. In some asymptomatic or minimally bothersome hernias, watchful waiting can be an option. The diagnosis and management of inguinal hernia is best done with an interprofessional team. All patients with an inguinal hernia should be referred to a general surgeon because there is always the potential for incarceration or strangulation.

• #3 Inguinal Hernias: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0615/p844.html/1000

  Inguinal hernias are one of the most common reasons a primary care patient may need referral for surgical intervention. The history and physical examination are usually sufficient to make the diagnosis. […] Examination involves feeling for a bulge or impulse while the patient coughs or strains. Although imaging is rarely warranted, ultrasonography or magnetic resonance imaging can help diagnose a hernia in an athlete without a palpable impulse or bulge on physical examination. […] The diagnosis of an inguinal hernia is usually made through history and physical examination findings. Although data are limited, in one report, the sensitivity and specificity of the physical examination were 75% and 96%, respectively. […] Hernias may be easily diagnosed with an adequate physical examination. The physical examination should begin by carefully inspecting the femoral and inguinal areas for bulges while the patient is standing.

• #4

  https://journals.lww.com/rhaw/fulltext/2022/05040/current_status_of_inguinal_hernia_management__a.1.aspx

  Groin hernias are the most common reason for primary care physicians to refer patients for surgical management. Diagnosis is usually clinical, with physical exam and history being sufficient enough to confirm diagnosis without imaging. […] Patients with symptomatic hernias should be offered surgical repair. The objective of this paper is to review the current status of the clinical diagnosis and management of patients with inguinal hernias. […] Inguinal hernias are primarily diagnosed by history and physical examination with secondary imaging rarely needed. Some patients with a clinical history suggestive of a hernia with no physical findings may need additional imaging studies to rule in or rule out the diagnosis. […] The goal is to insert the index finger into the external ring, and upon the patient performing a Valsalva maneuver, a soft impulse may be appreciated. Imaging with non-contrast magnetic resonance imaging (MRI) or computed tomography (CT) with Valsalva is recommended for diagnosing groin hernias when physical examination is insufficient.

• #5 Inguinal Hernias: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0615/p844.html/1000

  Inguinal hernias are one of the most common reasons a primary care patient may need referral for surgical intervention. The history and physical examination are usually sufficient to make the diagnosis. […] Examination involves feeling for a bulge or impulse while the patient coughs or strains. Although imaging is rarely warranted, ultrasonography or magnetic resonance imaging can help diagnose a hernia in an athlete without a palpable impulse or bulge on physical examination. […] The diagnosis of an inguinal hernia is usually made through history and physical examination findings. Although data are limited, in one report, the sensitivity and specificity of the physical examination were 75% and 96%, respectively. […] Hernias may be easily diagnosed with an adequate physical examination. The physical examination should begin by carefully inspecting the femoral and inguinal areas for bulges while the patient is standing.

• #6 Diagnosing and Deciding Whether to Treatment an Inguinal Hernia – International Guidelines – California Hernia Specialists

  https://californiaherniaspecialists.com/hernia-basics/diagnosing-deciding-whether-treatment-inguinal-hernia-international-guidelines/

  The first step in the workup for an inguinal hernia is obviously making an accurate diagnosis. […] By far the most common diagnostic test for determining the presence of an inguinal hernia is a Clinical Examination (CE). This involves a surgeon like myself examining the groin area for the signs of a hernia. […] Studies have shows that about 75% of hernias can be diagnosed with this technique. […] When found on an examination, hernia surgeons are accurate in the diagnosis 96% of the time. […] The most common imaging test is an ultrasound of the groin which increases the chances of finding a hernia to about 82%, with its accuracy about 95%. […] Most patients will never need an MRI or a CT scan to diagnose a hernia since the sensitivity is usually not much better than with CE and ultrasound.

• #7 Inguinal hernia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/inguinal-hernia/diagnosis-treatment/drc-20351553

  A physical exam is usually all that’s needed to diagnose an inguinal hernia. Your doctor will check for a bulge in the groin area. Because standing and coughing can make a hernia more prominent, you’ll likely be asked to stand and cough or strain. […] If the diagnosis isn’t readily apparent, your doctor might order an imaging test, such as an abdominal ultrasound, CT scan or MRI.

• #8 Inguinal Hernia: Types, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16266-inguinal-hernia

  A physical examination is usually enough to diagnose an inguinal hernia. Your healthcare provider will try to see and feel the hernia. They may ask you to cough or to bear down as though you were pooping to make the hernia emerge. […] If they can’t see the hernia from the outside, they may order an imaging test to see it from the inside. An ultrasound will usually do the trick, but in rare cases, they may need to use something more specific, like a CT scan.

• #9 Inguinal Hernia: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/digestive-disorders/inguinal-hernia

  See your doctor if you have symptoms of an inguinal hernia. Theyll check your groin area for swelling or a bulge. Theyll probably ask you to stand and cough. This can make a hernia more obvious. […] If your doctor doesnt see any swelling in the area, they may order imaging tests, such as an abdominal ultrasound, CT scan, or MRI. […] Your doctor can use ultrasound to easily diagnosis your hernia. This technology uses sound waves to create pictures of your internal organs and any other tissues. It’s a painless procedure that can often be done in a doctor’s office.

• #10 Abdominal Hernias Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/189563-clinical

  The first step in attempting to identify a hernia is to look for a swelling or mass in the area of the fascial defect. […] Strangulated hernias are differentiated from incarcerated hernias by the following: Pain out of proportion to examination findings, Fever or toxic appearance, Pain that persists after reduction of hernia. […] Examination of an adult for an inguinal hernia is best performed from the seated position, with the patient standing. […] If the hernia is not demonstrable in the supine position, the child should be examined in the upright position with intermittent manual pressure applied to the abdomen. […] If the visceral contents of a hernial sac cannot easily be reduced into the peritoneal cavity, the hernia is incarcerated. If the contents cannot be reduced at all, the hernia is irreducible.

• #11 Inguinal Hernias (Causes, Symptoms and Treatment)

  https://patient.info/doctor/inguinal-hernias

  Investigations […] Ultrasound is the less invasive method, if there is doubt. MRI or CT scanning may also be used. Herniography with injection of X-ray contrast agent into the peritoneum is rarely necessary. […] The clinical findings will help suggest whether the inguinal hernia is direct or indirect; in adults this is usually confirmed at operation. There may be a limit to the clinical utility of such a distinction, especially in adults. […] Examine the patient both standing and lying and ask them to cough or strain. Insert a finger through the top of the scrotum into the external inguinal ring and palpate for a lump when coughing – cough impulse. Sliding hernias are probable with large scrotal hernias.

• #12 Inguinal Hernias: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0615/p844.html/1000

  The diagnosis of an inguinal hernia is confirmed if an impulse or bulge is felt. […] If no bulge is detected with a Valsalva maneuver, a hernia is unlikely. However, athletic pubalgia (sports hernia) may be considered in athletes with groin pain and no bulge. […] It is more challenging to diagnose a hernia in female patients. […] Although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations (e.g., suspected sports hernia; recurrent hernia or possible hydrocele; uncertain diagnosis; surgical complications, especially chronic pain). […] The sensitivity of ultrasonography for the detection of groin hernias is greater than 90%, and the specificity is 82% to 86%. […] The choice of open vs. laparoscopic repair depends on surgeon preference, but only about 10 percent of inguinal hernia repairs in the United States are performed via a laparoscopic technique. […] The most common complications of hernia repair are hematomas, including penile or scrotal ecchymosis; seromas; and wound infection.

• #13 Inguinal Hernia: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/inguinal-hernia

  A doctor can usually diagnose an inguinal hernia during a physical exam. During the exam, they will ask you to cough while standing so they can check the hernia when its most noticeable. […] When its reducible, you or your doctor should be able to easily push an inguinal hernia back into your abdomen when youre lying down on your back. However, if this is unsuccessful, you may have an incarcerated or strangulated inguinal hernia.

• #14 Abdominal Hernias Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/189563-clinical

  The first step in attempting to identify a hernia is to look for a swelling or mass in the area of the fascial defect. […] Strangulated hernias are differentiated from incarcerated hernias by the following: Pain out of proportion to examination findings, Fever or toxic appearance, Pain that persists after reduction of hernia. […] Examination of an adult for an inguinal hernia is best performed from the seated position, with the patient standing. […] If the hernia is not demonstrable in the supine position, the child should be examined in the upright position with intermittent manual pressure applied to the abdomen. […] If the visceral contents of a hernial sac cannot easily be reduced into the peritoneal cavity, the hernia is incarcerated. If the contents cannot be reduced at all, the hernia is irreducible.

• #15 Inguinal Hernias: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0615/p844.html/1000

  The diagnosis of an inguinal hernia is confirmed if an impulse or bulge is felt. […] If no bulge is detected with a Valsalva maneuver, a hernia is unlikely. However, athletic pubalgia (sports hernia) may be considered in athletes with groin pain and no bulge. […] It is more challenging to diagnose a hernia in female patients. […] Although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations (e.g., suspected sports hernia; recurrent hernia or possible hydrocele; uncertain diagnosis; surgical complications, especially chronic pain). […] The sensitivity of ultrasonography for the detection of groin hernias is greater than 90%, and the specificity is 82% to 86%. […] The choice of open vs. laparoscopic repair depends on surgeon preference, but only about 10 percent of inguinal hernia repairs in the United States are performed via a laparoscopic technique. […] The most common complications of hernia repair are hematomas, including penile or scrotal ecchymosis; seromas; and wound infection.

• #16 Inguinal Hernias: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0615/p844.html/1000

  The diagnosis of an inguinal hernia is confirmed if an impulse or bulge is felt. […] If no bulge is detected with a Valsalva maneuver, a hernia is unlikely. However, athletic pubalgia (sports hernia) may be considered in athletes with groin pain and no bulge. […] It is more challenging to diagnose a hernia in female patients. […] Although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations (e.g., suspected sports hernia; recurrent hernia or possible hydrocele; uncertain diagnosis; surgical complications, especially chronic pain). […] The sensitivity of ultrasonography for the detection of groin hernias is greater than 90%, and the specificity is 82% to 86%. […] The choice of open vs. laparoscopic repair depends on surgeon preference, but only about 10 percent of inguinal hernia repairs in the United States are performed via a laparoscopic technique. […] The most common complications of hernia repair are hematomas, including penile or scrotal ecchymosis; seromas; and wound infection.

• #17 Diagnostics of Inguinal Hernias | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-662-55493-7_2

  For generations, careful physical examination of the groin in patients presenting with inguinal pathology has been regarded as an essential surgical skill. […] In current surgical practice, the presence of an inguinal hernia can be diagnosed quite accurately by history and physical examination, and additional diagnostic modalities are seldom needed. […] The presenting symptom of a groin hernia is either discomfort or pain in the groin in the majority of patients. […] Approximately one third of all patients is asymptomatic at presentation and presents with the sign of a non-tender bulge in the groin.

• #18 Inguinal Hernias: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0615/p844.html/1000

  The diagnosis of an inguinal hernia is confirmed if an impulse or bulge is felt. […] If no bulge is detected with a Valsalva maneuver, a hernia is unlikely. However, athletic pubalgia (sports hernia) may be considered in athletes with groin pain and no bulge. […] It is more challenging to diagnose a hernia in female patients. […] Although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations (e.g., suspected sports hernia; recurrent hernia or possible hydrocele; uncertain diagnosis; surgical complications, especially chronic pain). […] The sensitivity of ultrasonography for the detection of groin hernias is greater than 90%, and the specificity is 82% to 86%. […] The choice of open vs. laparoscopic repair depends on surgeon preference, but only about 10 percent of inguinal hernia repairs in the United States are performed via a laparoscopic technique. […] The most common complications of hernia repair are hematomas, including penile or scrotal ecchymosis; seromas; and wound infection.

• #19 Diagnosing Hernia | NYU Langone Health

  https://nyulangone.org/conditions/hernia/diagnosis

  Doctors at NYU Langone typically diagnose a hernia by taking a medical history and performing a physical exam. […] Sometimes, imaging tests are used to help doctors diagnose a hernia, particularly when the bulge is small or when symptoms can be confused with other conditions, such as endometriosis in women or kidney stones. […] Your doctor may recommend an MRI scan, particularly if your pain gets worse when you exercise. […] An MRI scan can detect a tear in the abdominal muscles. […] Your doctor may recommend an ultrasound if you are a woman of childbearing age. […] This test allows doctors to check for other pelvic conditions, such as ovarian cysts or fibroids, that can cause abdominal pain.

• #20 Which Imaging Techniques Are Best for Diagnosing Inguinal Hernias?

  https://borderradiology.com.au/which-imaging-techniques-are-best-for-diagnosing-inguinal-hernias/

  Accurate diagnosis of inguinal hernias is essential for effective treatment and patient management. Imaging plays a vital role in detecting, assessing, and confirming hernias, particularly in complex cases or when physical examination alone cannot provide a conclusive diagnosis. […] Early and accurate diagnosis is essential to prevent complications and determine the need for surgery. […] Several imaging modalities are available for diagnosing inguinal hernias, each with unique benefits and limitations. […] Ultrasound is often the first choice for diagnosing inguinal hernias due to its accessibility, cost-effectiveness, and safety profile. […] Ultrasound is ideal for initial diagnoses, assessing simple hernias, and imaging younger patients who require non-invasive methods. […] Computed Tomography (CT) scanning is a powerful imaging technique that provides cross-sectional images of the body, allowing for detailed visualisation of the abdominal structures.

• #21 Which Imaging Techniques Are Best for Diagnosing Inguinal Hernias?

  https://borderradiology.com.au/which-imaging-techniques-are-best-for-diagnosing-inguinal-hernias/

  Accurate diagnosis of inguinal hernias is essential for effective treatment and patient management. Imaging plays a vital role in detecting, assessing, and confirming hernias, particularly in complex cases or when physical examination alone cannot provide a conclusive diagnosis. […] Early and accurate diagnosis is essential to prevent complications and determine the need for surgery. […] Several imaging modalities are available for diagnosing inguinal hernias, each with unique benefits and limitations. […] Ultrasound is often the first choice for diagnosing inguinal hernias due to its accessibility, cost-effectiveness, and safety profile. […] Ultrasound is ideal for initial diagnoses, assessing simple hernias, and imaging younger patients who require non-invasive methods. […] Computed Tomography (CT) scanning is a powerful imaging technique that provides cross-sectional images of the body, allowing for detailed visualisation of the abdominal structures.

• #22 Ultrasound For Inguinal Hernia: Does Ultrasound Accurately Detect Hernia? | DRSONO

  https://drsono.com/blogs/news/ultrasound-for-inguinal-hernia/?srsltid=AfmBOooQ0AnZcCyLi85FSq28vdpJw0NT-j2U8wYMcVu68Jh7KVeiCE5M

  Ultrasound for inguinal hernia is a key procedure in diagnosis. […] Yes. An ultrasound can detect an inguinal hernia and even help know what type of hernia it is. […] In fact, the US National Institutes of Health (NIH) confirms that ultrasound imaging has become the most convenient procedure in diagnosing inguinal hernia. […] Research also shows that inguinal ultrasound has a high positive predictive value in determining whether a hernia should be operated on. […] An abdominal ultrasound is used to detect inguinal hernia. […] In an inguinal hernia diagnosis, an abdominal ultrasound follows a physical examination of the groin areas. […] It is recommended that ultrasound imaging for inguinal hernia be dynamic, involving postural changes that allow for a more precise diagnosis. […] For the same reason of differentiated anatomy, doctors need to perform a different ultrasound probe maneuver when diagnosing inguinal hernial in women. […] Proper clinical diagnosis is the best option for confirming an inguinal hernia. […] However, ultrasound is considered a gold standard in confirming diagnosis, determining the type of inguinal hernia, and deciding whether it requires repair surgery.

• #23 Inguinal Hernias: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0615/p844.html/1000

  The diagnosis of an inguinal hernia is confirmed if an impulse or bulge is felt. […] If no bulge is detected with a Valsalva maneuver, a hernia is unlikely. However, athletic pubalgia (sports hernia) may be considered in athletes with groin pain and no bulge. […] It is more challenging to diagnose a hernia in female patients. […] Although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations (e.g., suspected sports hernia; recurrent hernia or possible hydrocele; uncertain diagnosis; surgical complications, especially chronic pain). […] The sensitivity of ultrasonography for the detection of groin hernias is greater than 90%, and the specificity is 82% to 86%. […] The choice of open vs. laparoscopic repair depends on surgeon preference, but only about 10 percent of inguinal hernia repairs in the United States are performed via a laparoscopic technique. […] The most common complications of hernia repair are hematomas, including penile or scrotal ecchymosis; seromas; and wound infection.

• #24 Inguinal Hernia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513332/

  Inguinal hernia repair is an extremely common operation performed by surgeons. More than 800,000 repairs performed annually. Most patients present with a bulge or pain in the groin. Healthcare professionals recommend repairing all symptomatic hernias to avoid complications. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. Most inguinal hernias are diagnosed with a thorough history and physical examination. When history strongly suggests a hernia, but none can be elicited on an exam or in situations where body habitus makes physical examination limited, then a radiologic investigation may be warranted. Radiologic modalities include ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). An ultrasound can detect an inguinal hernia with a sensitivity of 86% and a specificity of 77%. CT scan can detect inguinal hernias with a sensitivity of 80% and specificity of 65%. MRI has a sensitivity of 95% and specificity of 96% in the detection of an inguinal hernia. Surgical repair is the definitive treatment for an inguinal hernia. As a general rule, all symptomatic inguinal hernias should be repaired when possible. In some asymptomatic or minimally bothersome hernias, watchful waiting can be an option. The diagnosis and management of inguinal hernia is best done with an interprofessional team. All patients with an inguinal hernia should be referred to a general surgeon because there is always the potential for incarceration or strangulation.

• #25

  https://link.springer.com/article/10.1007/s10029-020-02189-4

  The aim of the study was to determine which diagnostic modality [Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), or ultrasound (US)] is more precise in terms of sensitivity and specificity in diagnosing inguinal hernia and sub-type of inguinal hernia (direct or indirect). […] Bubble charts depicting the size of each patient cohort and percentual range for both sensitivity and specificity showed that US was better than CT and MRI in diagnosing inguinal hernia. […] We found that US had the highest sensitivity and specificity. However, it must be taken into consideration that performance is highly dependent on the operators level of expertise. Based on this systematic review, ultrasound may be the preferred imaging modality when physical examination is inconclusive, given that local expertise in performing US examination for hernia disease is adequate.

• #26 Positive predictive value of ultrasound in correctly identifying an inguinal hernia: a single-centered retrospective pilot study | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-022-01272-x

  To determine the clinical utility of preoperative ultrasound imaging for predicting an inguinal hernia in need of surgery. In addition, we aimed to identify factors associated with false positive (FP) ultrasound examinations. […] PPV of ultrasound examinations to identify an inguinal hernia in need of surgery correctly was 90.9% (159/175). […] With a false positive percentage of 9.1%, there is still room for improvement of preoperative diagnostic imaging. […] Preoperative ultrasound had a PPV of 90.9% (159/175) for identifying inguinal hernia in need of surgery. […] BMI was identified as most likely potential predictor of false positive ultrasounds. […] In our study, we found a PPV of preoperative ultrasound to predict an inguinal hernia in need of surgery of 90.9%; in other words 9.1% of patients underwent surgery without having an inguinal hernia. […] A higher BMI was identified as a potential predictor for FP results (p=0.043).

• #27 Positive predictive value of ultrasound in correctly identifying an inguinal hernia: a single-centered retrospective pilot study | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-022-01272-x

  To determine the clinical utility of preoperative ultrasound imaging for predicting an inguinal hernia in need of surgery. In addition, we aimed to identify factors associated with false positive (FP) ultrasound examinations. […] PPV of ultrasound examinations to identify an inguinal hernia in need of surgery correctly was 90.9% (159/175). […] With a false positive percentage of 9.1%, there is still room for improvement of preoperative diagnostic imaging. […] Preoperative ultrasound had a PPV of 90.9% (159/175) for identifying inguinal hernia in need of surgery. […] BMI was identified as most likely potential predictor of false positive ultrasounds. […] In our study, we found a PPV of preoperative ultrasound to predict an inguinal hernia in need of surgery of 90.9%; in other words 9.1% of patients underwent surgery without having an inguinal hernia. […] A higher BMI was identified as a potential predictor for FP results (p=0.043).

• #28 Which Imaging Techniques Are Best for Diagnosing Inguinal Hernias?

  https://borderradiology.com.au/which-imaging-techniques-are-best-for-diagnosing-inguinal-hernias/

  Accurate diagnosis of inguinal hernias is essential for effective treatment and patient management. Imaging plays a vital role in detecting, assessing, and confirming hernias, particularly in complex cases or when physical examination alone cannot provide a conclusive diagnosis. […] Early and accurate diagnosis is essential to prevent complications and determine the need for surgery. […] Several imaging modalities are available for diagnosing inguinal hernias, each with unique benefits and limitations. […] Ultrasound is often the first choice for diagnosing inguinal hernias due to its accessibility, cost-effectiveness, and safety profile. […] Ultrasound is ideal for initial diagnoses, assessing simple hernias, and imaging younger patients who require non-invasive methods. […] Computed Tomography (CT) scanning is a powerful imaging technique that provides cross-sectional images of the body, allowing for detailed visualisation of the abdominal structures.

• #29 Abdominal Hernias Workup: Approach Considerations, Laboratory Studies, Radiography

  https://emedicine.medscape.com/article/189563-workup

  Laboratory studies are not specific for hernia but may be useful for general medical evaluation. Imaging studies are not required in the normal workup of a hernia; however, radiography, computed tomography (CT), or ultrasonography (US) may be considered in certain circumstances. […] If an incarcerated or strangulated hernia is suspected, the following imaging studies may be helpful: upright chest radiograph to exclude free air (extremely rare); flat and upright abdominal films to diagnose a small bowel obstruction (neither sensitive or specific) or to identify areas of bowel outside the abdominal cavity. […] CT of the abdomen and pelvis with oral and intravenous (IV) contrast can help detect many elusive hernias by demonstrating extracoelomic location of the bowel, bladder, or female internal reproductive organs. […] US is helpful in narrowing the differential on both scrotal masses and masses below the inguinal ligament. It can also aid in the decision to drain or aspirate a nodal abscess.

• #30 Diagnostic Testing for Hernias: Understand the Different Types

  https://www.herniainfo.com/us/en/blog/diagnostic-testing-for-hernias

  A hernia is often diagnosed by clinical examination and typically appears as a small lump that looks more pronounced when you cough or do strenuous exercise, such as lifting something heavy. To diagnose a hernia, your doctor will feel for a lump and may ask you to stand from a seated position. He or she may also ask you to cough to make the hernia bulge more prominent. […] However, for a more informed diagnosis, your doctor may ask you to undergo a diagnostic procedure like an ultrasound, CT scan, or MRI scan. […] An ultrasound image can provide valuable insights into the size, location and characteristics of a hernia. This in turn can help your doctor create an individualized treatment plan specific to your hernia needs. […] CT scans can effectively detect complex hernias and evaluate potential complications such as hernia obstruction or strangulation. They are able to provide detailed anatomical information, aiding in treatment planning. […] MRIs provide detail and clarity, making them particularly useful for complex hernias or cases where surgical planning requires precise anatomical information.

• #31 Inguinal Hernia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513332/

  Inguinal hernia repair is an extremely common operation performed by surgeons. More than 800,000 repairs performed annually. Most patients present with a bulge or pain in the groin. Healthcare professionals recommend repairing all symptomatic hernias to avoid complications. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. Most inguinal hernias are diagnosed with a thorough history and physical examination. When history strongly suggests a hernia, but none can be elicited on an exam or in situations where body habitus makes physical examination limited, then a radiologic investigation may be warranted. Radiologic modalities include ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). An ultrasound can detect an inguinal hernia with a sensitivity of 86% and a specificity of 77%. CT scan can detect inguinal hernias with a sensitivity of 80% and specificity of 65%. MRI has a sensitivity of 95% and specificity of 96% in the detection of an inguinal hernia. Surgical repair is the definitive treatment for an inguinal hernia. As a general rule, all symptomatic inguinal hernias should be repaired when possible. In some asymptomatic or minimally bothersome hernias, watchful waiting can be an option. The diagnosis and management of inguinal hernia is best done with an interprofessional team. All patients with an inguinal hernia should be referred to a general surgeon because there is always the potential for incarceration or strangulation.

• #32 Hernia – Wikipedia

  https://en.wikipedia.org/wiki/Hernia

  Hernias can often be diagnosed based on signs and symptoms. […] Occasionally, medical imaging is used to confirm the diagnosis or rule out other possible causes. […] The diagnosis of hiatus hernias is often done by endoscopy. […] In the diagnosis of abdominal hernias, imaging is the principal means of detecting internal diaphragmatic and other nonpalpable or unsuspected hernias. […] Multidetector CT (MDCT) can show with precision the anatomic site of the hernia sac, the contents of the sac, and any complications. […] MDCT also offers clear detail of the abdominal wall allowing wall hernias to be identified accurately.

• #33 Inguinal Hernia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513332/

  Inguinal hernia repair is an extremely common operation performed by surgeons. More than 800,000 repairs performed annually. Most patients present with a bulge or pain in the groin. Healthcare professionals recommend repairing all symptomatic hernias to avoid complications. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. Most inguinal hernias are diagnosed with a thorough history and physical examination. When history strongly suggests a hernia, but none can be elicited on an exam or in situations where body habitus makes physical examination limited, then a radiologic investigation may be warranted. Radiologic modalities include ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). An ultrasound can detect an inguinal hernia with a sensitivity of 86% and a specificity of 77%. CT scan can detect inguinal hernias with a sensitivity of 80% and specificity of 65%. MRI has a sensitivity of 95% and specificity of 96% in the detection of an inguinal hernia. Surgical repair is the definitive treatment for an inguinal hernia. As a general rule, all symptomatic inguinal hernias should be repaired when possible. In some asymptomatic or minimally bothersome hernias, watchful waiting can be an option. The diagnosis and management of inguinal hernia is best done with an interprofessional team. All patients with an inguinal hernia should be referred to a general surgeon because there is always the potential for incarceration or strangulation.

• #34 Which Imaging Techniques Are Best for Diagnosing Inguinal Hernias?

  https://borderradiology.com.au/which-imaging-techniques-are-best-for-diagnosing-inguinal-hernias/

  CT is generally recommended for complex or unclear cases, particularly in older patients or those with recurrent hernias. […] Magnetic Resonance Imaging (MRI) is known for its high-contrast images, especially useful in soft tissue diagnosis. […] MRI is often reserved for complex or recurrent hernia cases, particularly when high-resolution soft tissue detail is required. […] The choice of imaging technique depends on multiple factors, including: Patient Age and Health Status: For younger patients or pregnant women, ultrasound is typically preferred to avoid radiation exposure. […] Yes, diagnostic guidelines generally recommend beginning with a physical examination followed by ultrasound, especially for simple cases. For complex, unclear, or recurrent hernias, CT or MRI may be required for confirmation. […] Inguinal hernias require accurate imaging for correct diagnosis and treatment. Whether it’s initial diagnosis through ultrasound, emergency assessment via CT, or complex evaluations using MRI, each imaging technique serves a specific purpose in patient care.

• #35 Diagnosing Hernia | NYU Langone Health

  https://nyulangone.org/conditions/hernia/diagnosis

  Doctors at NYU Langone typically diagnose a hernia by taking a medical history and performing a physical exam. […] Sometimes, imaging tests are used to help doctors diagnose a hernia, particularly when the bulge is small or when symptoms can be confused with other conditions, such as endometriosis in women or kidney stones. […] Your doctor may recommend an MRI scan, particularly if your pain gets worse when you exercise. […] An MRI scan can detect a tear in the abdominal muscles. […] Your doctor may recommend an ultrasound if you are a woman of childbearing age. […] This test allows doctors to check for other pelvic conditions, such as ovarian cysts or fibroids, that can cause abdominal pain.

• #36 How is a hernia diagnosed? – Northeast Georgia Health System

  https://www.nghs.com/2021/05/18/how-is-a-hernia-diagnosed

  MRI (magnetic resonance imaging). An MRI uses radio waves and a magnetic field to generate images of your organs and abdomen area. Your doctor may order an MRI if you have pain that is getting worse with exercise. Because exercise can cause a hernia without a bulge, an MRI can reveal tears in the abdomen.

• #37 Inguinal Hernias: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33064426/

  Groin hernias are caused by a defect of the abdominal wall in the groin area and comprise inguinal and femoral hernias. Inguinal hernias are more common in men. Although groin hernias are easily diagnosed on physical examination in men, ultrasonography is often needed in women. Ultrasonography is also helpful when a recurrent hernia, surgical complication after repair, or other cause of groin pain (e.g., groin mass, hydrocele) is suspected. Magnetic resonance imaging has higher sensitivity and specificity than ultrasonography and is useful for diagnosing occult hernias if clinical suspicion is high despite negative ultrasound findings. Herniography, which involves injecting contrast media into the hernial sac, may be used in selected patients. […] Becoming familiar with the common types of surgical interventions can help family physicians facilitate postoperative care and assess for complications, including recurrence. Laparoscopic repair is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair. Watchful waiting is a reasonable and safe option in men with asymptomatic or minimally symptomatic inguinal hernias. Watchful waiting is not recommended in patients with symptomatic hernias or in nonpregnant women.

• #38 Which Imaging Techniques Are Best for Diagnosing Inguinal Hernias?

  https://borderradiology.com.au/which-imaging-techniques-are-best-for-diagnosing-inguinal-hernias/

  CT is generally recommended for complex or unclear cases, particularly in older patients or those with recurrent hernias. […] Magnetic Resonance Imaging (MRI) is known for its high-contrast images, especially useful in soft tissue diagnosis. […] MRI is often reserved for complex or recurrent hernia cases, particularly when high-resolution soft tissue detail is required. […] The choice of imaging technique depends on multiple factors, including: Patient Age and Health Status: For younger patients or pregnant women, ultrasound is typically preferred to avoid radiation exposure. […] Yes, diagnostic guidelines generally recommend beginning with a physical examination followed by ultrasound, especially for simple cases. For complex, unclear, or recurrent hernias, CT or MRI may be required for confirmation. […] Inguinal hernias require accurate imaging for correct diagnosis and treatment. Whether it’s initial diagnosis through ultrasound, emergency assessment via CT, or complex evaluations using MRI, each imaging technique serves a specific purpose in patient care.

• #39 Inguinal hernia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/inguinal-hernia?lang=us

  Inguinal hernias (herniae also used) is the type of groin herniation (part of the larger group of abdominal wall hernias) that occurs above the inguinal ligament and through the inguinal canal. […] Patients most commonly present with swelling and/or pain in the relevant groin, iliac fossa, loin. Men may also have testicular pain. […] Surgical treatment options include herniorrhaphy and hernioplasty. […] Possible imaging differential considerations include femoral hernia: often remain lateral to the pubic tubercle and compress the femoral vein, hydrocele (may coexist), varicocele, spermatic cord hematoma, spermatic cord lipoma.

• #40 Abdominal Hernias Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/189563-clinical

  Attempts at reducing an incarcerated hernia are often successful; 80% of children do not need an immediate operation. […] A hydrocele usually transilluminates on examination; however, gas-filled intestines also transilluminate, thus precluding diagnostic aspiration. […] Hernias are the leading cause of intestinal obstruction in the world. […] The differential diagnosis of a groin mass inferior to the inguinal ligament and medial to the femoral vessels includes the following: Incarcerated femoral hernia, Lymphadenopathy secondary to a variety of inflammatory or neoplastic processes, Soft-tissue tumor. […] Peritoneal signs and intestinal obstruction suggest an incarcerated femoral hernia.

• #41 Vasitis: a rare diagnosis mimicking inguinal hernia: a case report | BMC Urology | Full Text

  https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0460-x

  A 50-year-old man presented with severe right inguinal and lower abdominal pain. Initial diagnosis at the emergency department was incarcerated or strangulated inguinal hernia. […] Cross-sectional imaging may be necessary to confirm the diagnosis and exclude differentials such as an inguinal hernia. […] The emergency doctor arranged computed tomography scan to rule out incarcerated inguinal hernia. […] The scan revealed diffuse edematous changes of right spermatic cord and vas deferens with peripheral fat stranding and no herniated bowel loop. […] Correlating the patients clinical symptoms, signs, and, imaging findings, the emergency doctor was able to overturn the initial diagnosis of an inguinal hernia and confirm vasitis. […] The common differential diagnoses include orchitis, epididymitis, testicular torsion, and inguinal hernia.

• #42 Groin Hernia: what it is, symptoms, diagnosis and treatment. Clínica Universidad de Navarra

  https://www.cun.es/en/diseases-treatments/diseases/groin-hernia

  „The diagnosis of inguinal hernia lies in the verification of the existence of protrusion at the hernia level, especially when performing abdominal stress maneuvers, coughing, etc., so that, most of the time, the physical examination reveals the presence of the hernia.” […] „Ultrasound and CT scans are useful for detecting small hernias.” […] „The differential diagnosis must be made especially with varicocele and hydrocele.”

• #43 Diagnosing Hernia | NYU Langone Health

  https://nyulangone.org/conditions/hernia/diagnosis

  Doctors at NYU Langone typically diagnose a hernia by taking a medical history and performing a physical exam. […] Sometimes, imaging tests are used to help doctors diagnose a hernia, particularly when the bulge is small or when symptoms can be confused with other conditions, such as endometriosis in women or kidney stones. […] Your doctor may recommend an MRI scan, particularly if your pain gets worse when you exercise. […] An MRI scan can detect a tear in the abdominal muscles. […] Your doctor may recommend an ultrasound if you are a woman of childbearing age. […] This test allows doctors to check for other pelvic conditions, such as ovarian cysts or fibroids, that can cause abdominal pain.

• #44 How is a hernia diagnosed? – Northeast Georgia Health System

  https://www.nghs.com/2021/05/18/how-is-a-hernia-diagnosed

  Hernias are generally pretty straightforward to diagnose. Our hernia repair specialists at the Hernia Center of Northeast Georgia Medical Center will review your symptoms and make a diagnosis based on a physical exam. Depending on the type of hernia he or she suspects, your doctor may order other diagnostic tests. […] Sometimes a hernia cannot be diagnosed through a physical exam alone, and other diagnostic tests are needed. Some examples of these include: […] Ultrasound. An ultrasound uses sound waves to generate images of your pelvic area and abdomen. In women, ultrasounds can help your doctor rule out other causes of pain, such as ovarian cysts or fibroids. In men, an ultrasound can help diagnose inguinal or scrotal hernias. […] CT scan (computer tomography). A CT scan uses X-ray technology to generate images of the abdominal area and organs. Typically, a CT scan is ordered to rule out other potential causes of abdominal pain and swelling.

• #45 Abdominal Hernias Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/189563-clinical

  The first step in attempting to identify a hernia is to look for a swelling or mass in the area of the fascial defect. […] Strangulated hernias are differentiated from incarcerated hernias by the following: Pain out of proportion to examination findings, Fever or toxic appearance, Pain that persists after reduction of hernia. […] Examination of an adult for an inguinal hernia is best performed from the seated position, with the patient standing. […] If the hernia is not demonstrable in the supine position, the child should be examined in the upright position with intermittent manual pressure applied to the abdomen. […] If the visceral contents of a hernial sac cannot easily be reduced into the peritoneal cavity, the hernia is incarcerated. If the contents cannot be reduced at all, the hernia is irreducible.

• #46 Hernia

  https://www.adena.org/types-of-care/conditions/hernias

  Hernias are typically diagnosed with a physical exam. Other tests, such as blood work, urinalysis, and CT scans may also be used to identify hernias. […] A bulge near the pubic bone; or pain, weakness, pressure or discomfort near the groin can be indications of an inguinal hernia. Other times, a physician may only recognize an inguinal hernia during a routine exam. Inguinal hernias account for nearly 75 percent of all hernia cases. […] Inguinal hernias can develop into incarcerated hernias if a portion of the intestine becomes entrapped in the abdominal wall, blocking the bowel and leading to pain and vomiting while preventing bowel and gas from moving.

• #47 Abdominal Hernias Workup: Approach Considerations, Laboratory Studies, Radiography

  https://emedicine.medscape.com/article/189563-workup

  Laboratory studies are not specific for hernia but may be useful for general medical evaluation. Imaging studies are not required in the normal workup of a hernia; however, radiography, computed tomography (CT), or ultrasonography (US) may be considered in certain circumstances. […] If an incarcerated or strangulated hernia is suspected, the following imaging studies may be helpful: upright chest radiograph to exclude free air (extremely rare); flat and upright abdominal films to diagnose a small bowel obstruction (neither sensitive or specific) or to identify areas of bowel outside the abdominal cavity. […] CT of the abdomen and pelvis with oral and intravenous (IV) contrast can help detect many elusive hernias by demonstrating extracoelomic location of the bowel, bladder, or female internal reproductive organs. […] US is helpful in narrowing the differential on both scrotal masses and masses below the inguinal ligament. It can also aid in the decision to drain or aspirate a nodal abscess.

• #48 Inguinal Hernia – Classification – Management – TeachMeSurgery

  https://teachmesurgery.com/general/small-bowel/inguinal-hernia/

  An inguinal hernia occurs when abdominal cavity contents enter the inguinal canal. […] They are the most common type of hernia and account for around 75% of all anterior abdominal wall hernias, with a prevalence of 4% in those over 45 years. […] A hernia is typically a clinical diagnosis. Current Royal College of Surgeons Guidelines state that imaging should only be considered in patients if there is diagnostic uncertainty or to exclude other pathology. […] If necessary, an ultrasound scan is recommended as first line imaging in the outpatient setting. For patients with features of obstruction or strangulation, CT imaging will be required. […] The diagnosis is a clinical one and only warrants further investigation if there is diagnostic uncertainty or features of complication.

• #49 Inguinal Hernias: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0615/p844.html/1000

  The diagnosis of an inguinal hernia is confirmed if an impulse or bulge is felt. […] If no bulge is detected with a Valsalva maneuver, a hernia is unlikely. However, athletic pubalgia (sports hernia) may be considered in athletes with groin pain and no bulge. […] It is more challenging to diagnose a hernia in female patients. […] Although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations (e.g., suspected sports hernia; recurrent hernia or possible hydrocele; uncertain diagnosis; surgical complications, especially chronic pain). […] The sensitivity of ultrasonography for the detection of groin hernias is greater than 90%, and the specificity is 82% to 86%. […] The choice of open vs. laparoscopic repair depends on surgeon preference, but only about 10 percent of inguinal hernia repairs in the United States are performed via a laparoscopic technique. […] The most common complications of hernia repair are hematomas, including penile or scrotal ecchymosis; seromas; and wound infection.

• #50 Inguinal Hernias: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33064426/

  Groin hernias are caused by a defect of the abdominal wall in the groin area and comprise inguinal and femoral hernias. Inguinal hernias are more common in men. Although groin hernias are easily diagnosed on physical examination in men, ultrasonography is often needed in women. Ultrasonography is also helpful when a recurrent hernia, surgical complication after repair, or other cause of groin pain (e.g., groin mass, hydrocele) is suspected. Magnetic resonance imaging has higher sensitivity and specificity than ultrasonography and is useful for diagnosing occult hernias if clinical suspicion is high despite negative ultrasound findings. Herniography, which involves injecting contrast media into the hernial sac, may be used in selected patients. […] Becoming familiar with the common types of surgical interventions can help family physicians facilitate postoperative care and assess for complications, including recurrence. Laparoscopic repair is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair. Watchful waiting is a reasonable and safe option in men with asymptomatic or minimally symptomatic inguinal hernias. Watchful waiting is not recommended in patients with symptomatic hernias or in nonpregnant women.

• #51 Inguinal Hernias: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33064426/

  Groin hernias are caused by a defect of the abdominal wall in the groin area and comprise inguinal and femoral hernias. Inguinal hernias are more common in men. Although groin hernias are easily diagnosed on physical examination in men, ultrasonography is often needed in women. Ultrasonography is also helpful when a recurrent hernia, surgical complication after repair, or other cause of groin pain (e.g., groin mass, hydrocele) is suspected. Magnetic resonance imaging has higher sensitivity and specificity than ultrasonography and is useful for diagnosing occult hernias if clinical suspicion is high despite negative ultrasound findings. Herniography, which involves injecting contrast media into the hernial sac, may be used in selected patients. […] Becoming familiar with the common types of surgical interventions can help family physicians facilitate postoperative care and assess for complications, including recurrence. Laparoscopic repair is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair. Watchful waiting is a reasonable and safe option in men with asymptomatic or minimally symptomatic inguinal hernias. Watchful waiting is not recommended in patients with symptomatic hernias or in nonpregnant women.

• #52 Ultrasound For Inguinal Hernia: Does Ultrasound Accurately Detect Hernia? | DRSONO

  https://drsono.com/blogs/news/ultrasound-for-inguinal-hernia/?srsltid=AfmBOooQ0AnZcCyLi85FSq28vdpJw0NT-j2U8wYMcVu68Jh7KVeiCE5M

  Ultrasound for inguinal hernia is a key procedure in diagnosis. […] Yes. An ultrasound can detect an inguinal hernia and even help know what type of hernia it is. […] In fact, the US National Institutes of Health (NIH) confirms that ultrasound imaging has become the most convenient procedure in diagnosing inguinal hernia. […] Research also shows that inguinal ultrasound has a high positive predictive value in determining whether a hernia should be operated on. […] An abdominal ultrasound is used to detect inguinal hernia. […] In an inguinal hernia diagnosis, an abdominal ultrasound follows a physical examination of the groin areas. […] It is recommended that ultrasound imaging for inguinal hernia be dynamic, involving postural changes that allow for a more precise diagnosis. […] For the same reason of differentiated anatomy, doctors need to perform a different ultrasound probe maneuver when diagnosing inguinal hernial in women. […] Proper clinical diagnosis is the best option for confirming an inguinal hernia. […] However, ultrasound is considered a gold standard in confirming diagnosis, determining the type of inguinal hernia, and deciding whether it requires repair surgery.

• #53

  https://journals.lww.com/rhaw/fulltext/2022/05040/current_status_of_inguinal_hernia_management__a.1.aspx

  The use of prosthetic mesh is recommended because of its association with a 50%-75% lower risk of hernia recurrence, lower risk of chronic pain post-operatively, and an earlier return to work compared with a sutured repair. […] The open repair with mesh (Lichtenstein tension-free) technique is the current gold standard of care for most patients with an inguinal hernia. […] Watchful waiting is not appropriate in women because of the increased incidence of hernia strangulation and difficulty in distinguishing inguinal from femoral hernias. Thus, surgical repair is routinely recommended for non-pregnant women with groin hernias. […] Diagnosis is typically made from history and physical examination.

• #54 Inguinal Hernias: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0615/p844.html/1000

  The diagnosis of an inguinal hernia is confirmed if an impulse or bulge is felt. […] If no bulge is detected with a Valsalva maneuver, a hernia is unlikely. However, athletic pubalgia (sports hernia) may be considered in athletes with groin pain and no bulge. […] It is more challenging to diagnose a hernia in female patients. […] Although imaging is rarely needed to diagnose a hernia, it may be useful in certain clinical situations (e.g., suspected sports hernia; recurrent hernia or possible hydrocele; uncertain diagnosis; surgical complications, especially chronic pain). […] The sensitivity of ultrasonography for the detection of groin hernias is greater than 90%, and the specificity is 82% to 86%. […] The choice of open vs. laparoscopic repair depends on surgeon preference, but only about 10 percent of inguinal hernia repairs in the United States are performed via a laparoscopic technique. […] The most common complications of hernia repair are hematomas, including penile or scrotal ecchymosis; seromas; and wound infection.

• #55 Inguinal Hernias: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33064426/

  Groin hernias are caused by a defect of the abdominal wall in the groin area and comprise inguinal and femoral hernias. Inguinal hernias are more common in men. Although groin hernias are easily diagnosed on physical examination in men, ultrasonography is often needed in women. Ultrasonography is also helpful when a recurrent hernia, surgical complication after repair, or other cause of groin pain (e.g., groin mass, hydrocele) is suspected. Magnetic resonance imaging has higher sensitivity and specificity than ultrasonography and is useful for diagnosing occult hernias if clinical suspicion is high despite negative ultrasound findings. Herniography, which involves injecting contrast media into the hernial sac, may be used in selected patients. […] Becoming familiar with the common types of surgical interventions can help family physicians facilitate postoperative care and assess for complications, including recurrence. Laparoscopic repair is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair. Watchful waiting is a reasonable and safe option in men with asymptomatic or minimally symptomatic inguinal hernias. Watchful waiting is not recommended in patients with symptomatic hernias or in nonpregnant women.

• #56 Inguinal hernia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/inguinal-hernia/

  Inguinal hernia is a clinical diagnosis. […] Imaging, preferably with ultrasound, is indicated if the clinical diagnosis is uncertain. […] Inguinal hernia is typically a clinical diagnosis; however, imaging may be useful if the clinical diagnosis is unclear or to investigate an underlying cause. […] Medical history should include: Identification of typical clinical features (e.g., of uncomplicated inguinal hernia). […] Physical examination should include: Palpation of the inguinal canal. […] To avoid missing inguinal hernias, routinely examine the inguinal canal in patients with unexplained acute abdominal pain and/or clinical features of bowel obstruction, especially in those with verbal impairment. […] First line; : ultrasound of the groin. […] Inconclusive ultrasound findings: CT or MRI abdomen and pelvis.

• #57 Which Imaging Techniques Are Best for Diagnosing Inguinal Hernias?

  https://borderradiology.com.au/which-imaging-techniques-are-best-for-diagnosing-inguinal-hernias/

  CT is generally recommended for complex or unclear cases, particularly in older patients or those with recurrent hernias. […] Magnetic Resonance Imaging (MRI) is known for its high-contrast images, especially useful in soft tissue diagnosis. […] MRI is often reserved for complex or recurrent hernia cases, particularly when high-resolution soft tissue detail is required. […] The choice of imaging technique depends on multiple factors, including: Patient Age and Health Status: For younger patients or pregnant women, ultrasound is typically preferred to avoid radiation exposure. […] Yes, diagnostic guidelines generally recommend beginning with a physical examination followed by ultrasound, especially for simple cases. For complex, unclear, or recurrent hernias, CT or MRI may be required for confirmation. […] Inguinal hernias require accurate imaging for correct diagnosis and treatment. Whether it’s initial diagnosis through ultrasound, emergency assessment via CT, or complex evaluations using MRI, each imaging technique serves a specific purpose in patient care.

• #58 Inguinal hernia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/inguinal-hernia/

  Complicated inguinal hernia: Consider CT abdomen and pelvis with IV contrast. […] A groin bulge with an expansile cough impulse above the inguinal ligament is diagnostic of an inguinal hernia. […] A palpable bulge confirms the diagnosis of an inguinal hernia. […] The following tests should be obtained in patients with strangulated inguinal hernia or incarcerated inguinal hernia with bowel obstruction for supportive diagnostic evidence and to assess for complications. […] Maintain a high index of suspicion for strangulation in patients with an incarcerated hernia and leukocytosis.

• #59 Inguinal hernia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/inguinal-hernia/

  Complicated inguinal hernia: Consider CT abdomen and pelvis with IV contrast. […] A groin bulge with an expansile cough impulse above the inguinal ligament is diagnostic of an inguinal hernia. […] A palpable bulge confirms the diagnosis of an inguinal hernia. […] The following tests should be obtained in patients with strangulated inguinal hernia or incarcerated inguinal hernia with bowel obstruction for supportive diagnostic evidence and to assess for complications. […] Maintain a high index of suspicion for strangulation in patients with an incarcerated hernia and leukocytosis.

• #60

  https://journals.lww.com/rhaw/fulltext/2022/05040/current_status_of_inguinal_hernia_management__a.1.aspx

  Groin hernias are the most common reason for primary care physicians to refer patients for surgical management. Diagnosis is usually clinical, with physical exam and history being sufficient enough to confirm diagnosis without imaging. […] Patients with symptomatic hernias should be offered surgical repair. The objective of this paper is to review the current status of the clinical diagnosis and management of patients with inguinal hernias. […] Inguinal hernias are primarily diagnosed by history and physical examination with secondary imaging rarely needed. Some patients with a clinical history suggestive of a hernia with no physical findings may need additional imaging studies to rule in or rule out the diagnosis. […] The goal is to insert the index finger into the external ring, and upon the patient performing a Valsalva maneuver, a soft impulse may be appreciated. Imaging with non-contrast magnetic resonance imaging (MRI) or computed tomography (CT) with Valsalva is recommended for diagnosing groin hernias when physical examination is insufficient.

• #61 Diagnosing and Deciding Whether to Treatment an Inguinal Hernia – International Guidelines – California Hernia Specialists

  https://californiaherniaspecialists.com/hernia-basics/diagnosing-deciding-whether-treatment-inguinal-hernia-international-guidelines/

  Patients who have symptoms at the time they see me in our office, should have surgery. […] Thus, in patients with symptoms, I recommend surgery at that time. […] In patients who watch their hernia over time, the chances of developing pain or other symptoms and crossing over to having surgery is about 75%. […] Regardless, about 3 out of every 4 patients who just watches his or her hernia will need surgery at some point.

• #62 Inguinal Hernia – Classification – Management – TeachMeSurgery

  https://teachmesurgery.com/general/small-bowel/inguinal-hernia/

  An inguinal hernia occurs when abdominal cavity contents enter the inguinal canal. […] They are the most common type of hernia and account for around 75% of all anterior abdominal wall hernias, with a prevalence of 4% in those over 45 years. […] A hernia is typically a clinical diagnosis. Current Royal College of Surgeons Guidelines state that imaging should only be considered in patients if there is diagnostic uncertainty or to exclude other pathology. […] If necessary, an ultrasound scan is recommended as first line imaging in the outpatient setting. For patients with features of obstruction or strangulation, CT imaging will be required. […] The diagnosis is a clinical one and only warrants further investigation if there is diagnostic uncertainty or features of complication.

• #63 Inguinal hernia in adults – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/723

  An inguinal hernia occurs when abdominal or pelvic contents protrude through a dilated internal ring or attenuated inguinal floor in the inguinal canal. […] Diagnosis is usually clinical; imaging may be helpful where there is doubt about diagnosis, but also identifies many clinically insignificant apparent hernias. […] Key diagnostic factors include groin discomfort or pain with bulge, groin mass, and abdominal discomfort or pain. […] 1st investigations to order include clinical diagnosis. […] Investigations to consider include ultrasound scan of groin, CT scan, and MRI of groin.

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