← Diagnosis and Management Guides
Inguinal Hernia
Key considerations: Incarcerated hernia, Strangulated hernia, Testicular torsion
Cannot miss
- Incarcerated hernia
- Strangulated hernia
- Testicular torsion
Likely diagnoses
- Indirect inguinal hernia
- Direct inguinal hernia
- Femoral hernia
- Inguinal lymphadenopathy
- Hydrocele
Red flags
- Non-reducible hernia
- Tenderness over hernia
- Vomiting/obstruction signs
- Overlying skin changes
Workup
- history: Groin bulge with straining/standing, pain, reducibility, obstructive symptoms; exam: Standing exam with Valsalva, cough impulse, assess for reducibility; labs: CBC, BMP, lactate if incarceration suspected; imaging: Ultrasound if diagnosis uncertain; CT abdomen/pelvis if obstruction suspected; bedside: Assess reducibility with gentle pressure
Management
- immediate: Incarcerated: attempt gentle reduction (Trendelenburg, sedation, ice); Strangulated: emergent surgery — do NOT attempt reduction; general: Elective repair for symptomatic hernias; Watchful waiting acceptable for minimally symptomatic inguinal hernias; All femoral hernias should be repaired (high strangulation risk)
Disposition
- admit: Incarcerated hernia unable to reduce, strangulated hernia, signs of bowel obstruction; discharge: Reducible hernia with surgical referral; consults: Surgery for all incarcerated/strangulated hernias
Clinical pearls
- Femoral hernias have ~40% incarceration rate — ALL should be repaired
- Indirect hernias are lateral to inferior epigastric vessels; direct are medial
- Never attempt reduction if strangulation suspected (necrotic bowel could be returned to abdomen)
Source and review
- HerniaSurge Guidelines 2018. Last reviewed: 2024-11-01