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Inguinal Hernia

SUBJECT: Ultrasound for Inguinal Hernia

SECTION: Radiology Ultrasound     

ORIGINATOR: Jody Riherd, MD

REVIEW DATE: September 13, 2013

Role of US

  • To confirm the presence of a hernia
  • To distinguish between inguinal vs femoral hernia
  • If inguinal, to subclassify direct vs indirect
  • To identify the content of the hernia (omental fat +/- bowel)
  • Reducible vs non-reducible
  • Is it symptomatic (focally tender or not)
  • Identify alternative pathology

Equipment

  • Use a linear transducer 7-12MHz

Begin supine.  If no hernia detected, reexamine erect.

To find the internal inguinal canal: Start from down at the common femoral vessels and work your way in a transverse plane superiorly until you reach the level above where the inferior epigastric vessels join the ext. iliac vein and artery.

  • Turn the probe to go along the plane of the inguinal canal/inguinal ligament.
  • Valsalva
  • Watch for movement of omentum/or bowel within the canal or medial to it.
  • If there is sliding down the canal this is usually an indirect hernia as it originates lateral to the epigastric vessels.
  • If there is medial movement to the IEV then this is a direct hernia and it does not usually communicate with the inguinal canal.
  • Check if the omentum/bowel is free to move back within the peritoneum (reducible hernia) or does it gets stuck (strangulated).

To find a femoral hernia: Scan transversely over common femoral vessels and look medial to the vessels when the patient strains.

  • The lump will present lateral and caudal to the pubic ramus.
  • With a hernia present, the common femoral vein will not expand as it normally should. As it pushes through the femoral canal, the hernia will compress the vein.

Images acquired

  • Inguinal canal at rest and straining in 2 planes (Long axis is along plane of inguinal ligament. Transverse is perpendicular to the inguinal ligament)
  • Femoral canal at rest and straining in 2 planes (Long axis along plane of femoral vein, transverse to femoral vein)
  • Cine if positive for hernia
  • Contralateral groin images are not required to document, but evaluate and document images if there are questions or confusion with the ipsilateral side
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