Inguinal Hernia

General Considerations

• Indirect inguinal hernia
  
  
• Through inguinal canal extending into scrotal sac (in males)
• Lateral to inferior epigastric vessels
• Most common
• Failure of obliteration of processus vaginalis
• Bilateral 20% of time

Clinical Findings

• Fullness at site of hernia
• Symptoms of bowel obstruction
• Nausea and vomiting
• Symptoms of bowel ischemia
• Toxic

Imaging Findings

• Bowel loops projecting into scrotum or over obturator foramen on conventional radiographs
• Bowel and/or omentum (fat) or sometimes visceral organs protruding through peritoneum
• Bowel or fat in hernia sac
• Stranding of fat suggest the possibility of incarceration
• Proximal bowel dilatation from obstruction
• Bowel wall thickening, extraluminal fluid,  severe fat stranding and engorged mesenteric vessels suggest strangulation

 
Inguinal Hernia. There is air (white arrows) in bowel projecting below the obturator foramen (red arrow), into the scrotal sac. Although air in bowel may project in this location in markedly obese patients, the unilateral nature of this finding suggests a hernia.