An inguinal hernia is a bulge of fat or bowel through a weak spot in the lower abdominal wall into the groin. It is far more common in men, and the main danger is incarceration, where the hernia gets stuck and its blood supply can be cut off.
Key symptoms
- Bulge in the groin that grows with standing, coughing or lifting
- Heavy or dragging feeling in the groin
- Aching that gets better when lying down
- Swelling that may reach the scrotum
What you find on exam
- Examine standing and lying; ask the patient to cough or strain
- Feel for an impulse at the inguinal canal
- Try gentle reduction and note if it goes back in
- Check for tenderness, redness or firmness over the bulge
- Examine the other side and the scrotum
Tests
- Usually a clinical diagnosis
- Ultrasound if the exam is unclear
- CT if incarceration or bowel obstruction is suspected
Treatment basics
- Watchful waiting is reasonable for small, painless hernias in men
- Elective repair (open or laparoscopic with mesh) for symptomatic hernias
- Gentle reduction of an incarcerated hernia if there are no signs of strangulation
- Emergency surgery for strangulation
- Avoid heavy lifting until repaired
Red flags
- Painful, tender bulge that will not go back in
- Red or dark skin over the hernia
- Vomiting, distension and no passage of gas (bowel obstruction)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.