Indirect and direct inguinal hernia ct

AMER SHAKIL, MD, MBA, KIMBERLY APARICIO, MD, ELIZABETH BARTA, DO, AND KRISTAL MUNEZ, MD

Am Fam Physician. 2020;102(8):487-492

Patient information: See related handout on inguinal (groin) hernias, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

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.

Hernias are a common reason for primary care physicians to refer patients for surgical management. There are many different types of hernias, with most occurring in the abdomen or groin. The term groin hernia comprises three types of hernias depending on location relative to the inguinal (Hesselbach) triangle (Figure 1 1 ): direct inguinal, indirect inguinal, and femoral. A direct inguinal hernia is a protrusion of tissue through the posterior wall of the inguinal canal, medial to the inferior epigastric vessels (Figure 2 1 ), whereas an indirect inguinal hernia protrudes through the internal inguinal ring, lateral to the inferior epigastric vessels (Figure 3 1 ). A femoral hernia is the protrusion of tissue below the inguinal ligament, medial to the femoral vessels.