Hernia: Weakness or defect in fibromuscular wall with protrusion of organ or part of organ through defect

US accurate at detecting hernia sac and contents as well as fascial defect

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  Increase in hernia size during cough, Valsalva maneuver, or standing

Direct inguinal hernia passes through transversalis fascial defect in Hesselbach triangle

Indirect inguinal hernia passes through deep inguinal ring, extends along inguinal canal, and emerges at superficial inguinal ring, extending to scrotal sac

Femoral hernia passes through femoral canal into superomedial thigh, accompanying femoral vessels

Color Doppler helps identify inferior epigastric artery and its relationship to hernia neck for inguinal hernias

CT or MR: Useful if US is equivocal, better for detecting alternative causes of symptoms

Contents

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  Omental fat: Echogenic tissue without peristalsis

  
  
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  Bowel loops: Layers; “target” echo pattern with strong central echoes representing air or fluid in lumen

  
  
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  Bowel peristalsis best assessed in real time

  
  
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  Fluid

Reducible hernia: Decrease in hernia size with decrease in intraabdominal pressure or application of external pressure to hernial sac with transducer

Incarcerated: Nonreducible

Nonobstructed hernia: Active peristalsis ± movement of intestinal contents

Strangulated hernia: Compromised vascular supply of contents, thickened sac, fluid, thickened bowel, echogenic fat

Obstructed hernia: Absence of peristalsis or hyperperistaltic loops in hernia, dilated/thick bowel loops in hernia sac or abdomen

Lipoma of spermatic cord

Encysted hydrocele canal of Nück

Inguinal canal lesions

Hernia repair is most common surgical procedure in US

Indirect inguinal hernia: Young to middle aged, 5-10x more common in males

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  Children = patent processus vaginalis

Direct inguinal hernia nearly always in males, ↑ with ↑ age

Femoral hernia: More common in female, older patients

Groin lump or discomfort with positive cough impulse, constant or intermittent

Obstruction or strangulation more common with femoral hernias due to narrow neck

Localize inferior epigastric artery, provoke hernia