Diagnostic Ultrasound - Abdomen and Pelvis

Groin Hernia
Diagnoses: Abdominal Wall/Peritoneal Cavity
TERMINOLOGY
• Hernia: Weakness or defect in fibromuscular wall with
protrusion of organ or part of organ through defect
• Reducible hernia: Decrease in hernia size with decreased
intraabdominal pressure or application of external pressure
• Incarcerated: Nonreducible
• Strangulated: Compromised vascular supply of hernia
contents
IMAGING
• Indirect inguinal hernia passes through deep inguinal ring,
extends along inguinal canal, and emerges at superficial
inguinal ring
• Direct inguinal hernia passes through transversalis fascial
defect in Hesselbach triangle
• Femoral hernia passes through femoral canal into
superomedial thigh
• Ultrasound accurate at detecting hernia sac and contents as
well as fascial defect at rest or with provocative maneuvers
KEY FACTS
○ Increase in hernia size during cough, Valsalva maneuver,
or standing
• Color Doppler helps identify inferior epigastric artery and
its relationship to hernia neckfor inguinal hernias
• CT or MR: Useful if ultrasound is equivocal, better for
detecting alternative causes of symptoms
TOP DIFFERENTIAL DIAGNOSES
• Lipoma of spermatic cord
• Encysted hydrocele canal of Nück
• Inguinal canal lesions
CLINICAL ISSUES
• Obstruction or strangulation more common with femoral
hernias due to narrow neck
(Left) Graphic shows 3 types of
groin hernia: Direct ſt and
indirect inguinal hernias
arise above the inguinal
ligament , medial and
lateral to the inferior
epigastric vessels st
respectively; femoral hernias
arise below the inguinal
ligament medial to femoral
vessels . (Right) Transverse
ultrasound of the right groin
shows a direct inguinal hernia
containing small bowel ſt.
The hernia neck was medial to
the inferior epigastric vessels
st. The small bowel was only
seen during Valsalva or while
standing.
(Left) Transverse ultrasound
shows a left direct-type
inguinal hernia ſt containing
bowel. The neck of the
hernia lies medial to the
inferior epigastric vessels st.
(Right) Transverse color
Doppler ultrasound of the
same left direct inguinal
hernia ſt during Valsalva
maneuver is shown. The hernia
sac is larger. The hernia neck
is medial to the inferior
epigastric vessels st. Direct
inguinal hernias rarely
obstruct.
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