Tests
1st tests to order
clinical diagnosis
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
Tests to consider
ultrasound scan of groin
Test
May be useful when there is diagnostic uncertainty.[48][49][53] If imaging is required, an ultrasound scan of the groin should be the initial investigation.[2]
However, avoid routine use of ultrasound to evaluate a clinically apparent inguinal hernia. Palpable abdominal wall hernias can be reliably diagnosed by history and physical exam alone. Routine use of ultrasonography in the setting of a clearly palpable defect adds unnecessary cost and treatment delay with no benefit to surgical care.[47]
Result
may identify occult hernias; clinically insignificant false-positive findings interpreted as hernias may also be reported
CT scan
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 maneuver is performed during scanning. CT abdomen and pelvis has demonstrated sensitivities of 54% to 80% and specificities of 25% to 65%.[51][52]
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
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%.[52]
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)
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