Abstract
Swelling and pain in the groin are a common presentation for the abdominal surgeon. Nevertheless, diagnosis of a problem in the groin can still, in some cases, be a difficult clinical dilemma. It is fair to say that the diagnosis of an obvious swelling in the groin is usually straightforward, in terms of a hernia being present or not. However, the traditional inguinoscrotal hernia, where the hernial sac passes down into the scrotum, is a relatively uncommon event. Coupled with the increasing body mass index of the population, it is increasingly common for even a large groin hernia not to result in an obvious groin swelling. In some cases, where there is diagnostic doubt, thinking about several key questions may focus the investigation pathway:
-
Groin symptoms but no swelling, is there a hernia?
-
Groin swelling, but is it a hernia?
-
Hernia, but is it causing the symptoms?
Similar content being viewed by others
References
Hair A, Paterson C, Wright D, Baxter JN, O’Dwyer PJ. What effect does the duration of an inguinal hernia have on patient symptoms? J Am Coll Surg. 2001;193:125–9.
Chung L, Norrie J, O’Dwyer PJ. Long-term follow-up of patients with a painless inguinal hernia from a randomized trial. Br J Surg. 2011;98:596–9.
Smith GD, Crsoby DL, Lewis PA. Inguinal hernia and a single stressful event. Ann R Coll Surg Engl. 1996;78:367–8.
Pathak S, Poston GJ. It is highly unlikely that the development of an abdominal wall hernia can be attributable to a single strenuous event. Ann R Coll Surg Engl. 2006;88:168–71.
Schofield PF. Inguinal hernia: medicolegal implications. Ann R Coll Surg Engl. 2000;82:109–10.
Hair A, Paterson C, O’Dwyer PJ. Diagnosis of a femoral hernia in the elective setting. J R Coll Surg Edinb. 2001;46:117–8.
Harissis HV, Douitsis E, Fatouros M. Incarcerated hernia: to reduce or not to reduce. Hernia. 2009;13:263–6.
Derici H, Unalp HR, Bozdaq AD. Factors affecting morbidity and mortality in incarcerated abdominal wall hernia. Hernia. 2007;11:341–6.
Kemler MA, Oostvogel HJM. Femoral hernia: is a conservative policy justified? Eur J Surg. 1997;163:187–90.
Horn TW, Harris JA, Martindale R, Gadacz T. When a hernia is not a hernia: the evaluation of inguinal hernias in the cirrhotic patient. Am Surg. 2001;67:1093–5.
Fawcett AN, Rooney PS. Inguinal canal lipoma. Br J Surg. 1997;84:1169–70.
Read RC, White HJ. Lipoma of the spermatic cord, fatty herniation, liposarcoma. Hernia. 2000;4:149–54.
Sozutek A, Irkorucu O, Reyhan E, et al. A giant aggressive angiomyxoma of the pelvis misdiagnosed as incarcerated femoral hernia: a case report and review of the literature. Case Rep Surg. 2016;2016:1–6.
Valeshabad AK, et al. An important mimic of inguinal hernia. Urology. 2016;97:e11.
Buchs NC, Bloemendaal AL, Guy RJ. Localized peritoneal carcinomatosis mimicking an irreducible left inguinal hernia. Ann R Coll Surg Engl. 2016;98(3):e52–4.
Sarkar S, Panja S, Kumar S. Hydrocele of the canal of Nuck (female hydrocele): a rare differential for inguinal-labial swelling. J Clin Diagn Res. 2016;10(2):PD21–2.
Pandey D, Coondoo A, Shetty J, Mathew S. Jack in the box: inguinal endometriosis. BMJ Case Rep. 2015;2015. https://doi.org/10.1136/bcr-2014-207988.
Henriksen NA, Bisgaard Thorup J, Jorgensen LN. Unsuspected femoral hernia in patients with a prospective diagnosis of recurrent inguinal hernia. Hernia. 2012;16:381–5.
Ashby EC. Chronic obscure groin pain is commonly caused by enthesopathy: ‘tennis elbow’ of the groin. Br J Surg. 1994;81:1632–4.
Macleod DAD, Gibbon WW. The sportsman’s groin. Br J Surg. 1999;86:849–50.
Eames NWA, Deans GT, Lawson JT, Irwin ST. Herniography for occult hernia and groin pain. Br J Surg. 1994;81:1529–30.
Allen RP, Condon VR. Transitory extraperitoneal hernia of the bladder in infants (bladder ears). Radiology. 1961;77:979–83.
Sternhill B, Schwartz S. Effect of hypaque on mouse peritoneum. Radiology. 1960;75:81–4.
Ducharme JC, Bertrand R, Chacar R. Is it possible to diagnose inguinal hernia by x-ray? J Can Assoc Radiol. 1967;18:448.
Gullmo A. Herniography. World J Surg. 1989;13:560–8.
Hamlin JA, Kahn AM. Herniography in symptomatic patients following inguinal hernia repair. West J Med. 1995;162:28–31.
Harrison LA, Keesling CA, Martin NL, Lee KR, Wetzel LH. Abdominal wall hernias: review of herniography and correlation with cross-sectional imaging. Radiographics. 1995;15:315–32.
Hachem MI, Saunders MP, Rix TE, Anderson HJ. Herniography: a reliable investigation avoiding needless groin exploration—a retrospective study. Hernia. 2009;13:57–60.
MacArthur DC, Grieve DC, Thompson JD, Greig JD, Nixon SJ. Herniography for groin pain of uncertain origin. Br J Surg. 1997;84:684–5.
Heise CP, Sproat IA, Starling JR. Peritoneography (herniography) for detecting occult inguinal hernia in patients with inguinodynia. Ann Surg. 2002;235:140–4.
Djuric-Stefanovic A, Saranovic D, Ivanovic A, et al. The accuracy of ultrasonography in classification of groin hernias according to the criteria of the unified classification system. Hernia. 2008;12:395–400.
Depasquale R, Landes C, Doyle G. Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained. Clin Radiol. 2009;64:608–14.
Gupta H, Subedi N, Robinson P. Effectiveness of sonography in detecting clinically occult femoral hernias. J Ultrasound Med. 2016;35:1675–9.
Lawrenz K, Hollman AS, Carachi R, Cacciagnerra S. Ultrasound assessment of the contralateral groin in infants with unilateral inguinal hernia. Clin Radiol. 1994;49:546–8.
Kawaguchi AL, Shaul DB. Inguinal hernias can be accurately diagnosed using the parent’s digital photographs when the physical examination is nondiagnostic. J Pediatr Surg. 2009;44:2327–9.
Chen KC, Chu CC, Chou TY, Wu CJ. Ultrasound for inguinal hernias in boys. J Pediatr Surg. 1999;34:1890–1.
Zhang GQ, Sugiyama M, Hagi H, Urata T, Shimamori N, Atomi Y. Groin hernias in adults; value of colour Doppler sonography in their classification. J Clin Ultrasound. 2001;29:429–34.
Lee RK, Griffith JF, Ng WH. High accuracy of ultrasound in diagnosing the presence and type of groin hernia. J Clin Ultrasound. 2015;43:538–47.
Jacobson JA, Khoury V, Brandon CJ. Ultrasound of the groin: techniques, pathology and pitfalls. Am J Roentgenol. 2015;205:513–23.
Cherian PT, Parnell AP. The diagnosis and classification of inguinal and femoral hernia on multisection spiral CT. Clin Radiol. 2008;63:184–92.
Kitami M, Takase K, Tsuboi M, et al. Differentiation of femoral and inguinal hernias on the basis of anteroposterior relationship to the inguinal ligament on multidimensional computed tomography. J Comput Assist Tomogr. 2009;33:678–81.
Hahn-Pederson J, Lund L, Hansen-Hojhus J, Bojsen-Muller F. Evaluation of direct and indirect inguinal hernia by computed tomography. Br J Surg. 1994;81:569–72.
Garvey JF. Computed tomography scan diagnosis of occult groin hernia. Hernia. 2012;16:307–14.
Omar IM, Zoga AC, Kavanagh EC, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28:1415–38.
Barile A, Erriquez D, Cacchio A, DePaulis F, Di Cesare E, Masciocchi C. Groin pain in athletes: role of magnetic resonance. Radiol Med. 2000;100:216–22.
Leander P, Ekberg O, Sjoberg S, Kesek P. MR imaging following herniography in patients with unclear groin pain. Eur Radiol. 2000;10:1691–6.
Robinson A, Light D, Kasim A, Nice C. A systematic review and meta-analysis of the role of radiology in the diagnosis of occult inguinal hernia. Surg Endosc. 2013;27:11–8.
Miller J, Cho J, Michael MJ, Saouaf R, Towfigh S. Role of imaging in the diagnosis of occult hernias. JAMA Surg. 2014;149:1077–80.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
de Beaux, A.C., Patel, D. (2018). Diagnosis of a Lump in the Adult Groin. In: LeBlanc, K., Kingsnorth, A., Sanders, D. (eds) Management of Abdominal Hernias. Springer, Cham. https://doi.org/10.1007/978-3-319-63251-3_11
Download citation
DOI: https://doi.org/10.1007/978-3-319-63251-3_11
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-63250-6
Online ISBN: 978-3-319-63251-3
eBook Packages: MedicineMedicine (R0)