Investigations

1st investigations to order

clinical diagnosis

Test
Result
Test

Most inguinal hernias are diagnosed clinically by observation and palpation. Additional investigations are not usually required. Imaging may be useful when there is diagnostic uncertainty (e.g., in a very obese patient, or other complex cases).

Result

accurately detects clinically significant inguinal hernias

Investigations to consider

ultrasound scan of groin

Test
Result
Test

May be useful when there is diagnostic uncertainty.[50][51][55] If imaging is required, an ultrasound scan of the groin should be the initial investigation.[49]

Result

may identify occult hernias; clinically insignificant false-positive findings interpreted as hernias may also be reported

CT scan

Test
Result
Test

A computed tomography (CT) scan of the groin is indicated if the ultrasound scan is negative and clinical suspicion is high. Diagnostic accuracy is improved if an oral contrast agent is administered and a Valsalva manoeuvre is performed during scanning. CT abdomen and pelvis has demonstrated sensitivities of 54% to 80% and specificities of 25% to 65%.[53][54]

Result

may misleadingly identify asymptomatic, fatty tissue in the inguinal canal (cord lipomas) as hernias; clinical correlation is required as these are often not true hernias

MRI of groin

Test
Result
Test

Only used in patients with clinically uncertain herniation. In a retrospective study of patients with suspected occult inguinal hernia, MRI demonstrated sensitivity of 91% and specificity of 92%.[54]

Result

hernia appears as abnormal widening of the anteroposterior diameter of the inguinal canal and/or simultaneous protrusion of abnormal content (fat and/or bowel) within the inguinal canal (either originating from the posterior wall of the inguinal canal or through the internal inguinal ring)[56]

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