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{{Adult top}} [[inguinal hernia (peds)]]
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{{Adult top}}
<translate> [[Special:MyLanguage/inguinal hernia (peds)|inguinal hernia (peds)]]
 
==Background==
==Background==
[[File:Gray1144.png|thumb|Scrotal anatomy]]
[[File:Gray1144.png|thumb|Scrotal anatomy]]
[[File:Inguinalhernia (1).gif|thumb|Anatomy of an inguinal hernia.]]
[[File:Inguinalhernia (1).gif|thumb|Anatomy of an inguinal hernia.]]
===Classification===
===Classification===
*Reducible
*Reducible
**Hernia sac soft, easy to replace back through the hernia defect
**Hernia sac soft, easy to replace back through the hernia defect
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**Impairment of blood flow
**Impairment of blood flow
**Severe pain at hernia site
**Severe pain at hernia site
**Signs of [[SBO|intestinal obstruction]]
**Signs of [[Special:MyLanguage/SBO|intestinal obstruction]]
**Skin changes overlying hernia sac may be seen
**Skin changes overlying hernia sac may be seen


===Types===
===Types===
*Inguinal (75%)
*Inguinal (75%)
**Most common type of hernia in both men and women
**Most common type of hernia in both men and women
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**Often presents with out vomiting or intestinal obstruction
**Often presents with out vomiting or intestinal obstruction
***As a result, more likely to diagnose once wall has begun to become ischemic
***As a result, more likely to diagnose once wall has begun to become ischemic


==Clinical Features==
==Clinical Features==
[[File:Inguinal hernia right view.jpg|thumb|Adult male right-sided with inguinal hernia.]]
[[File:Inguinal hernia right view.jpg|thumb|Adult male right-sided with inguinal hernia.]]
[[File:Inguinal hernia.JPG|thumb]]
[[File:Inguinal hernia.JPG|thumb]]
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**If incarcerated, nonreducible
**If incarcerated, nonreducible
**If strangulated, nonreducible and may have overlying skin changes
**If strangulated, nonreducible and may have overlying skin changes
*+/- [[abdominal pain|abdominal]]/groin/[[testicular Pain]]
*+/- [[Special:MyLanguage/abdominal pain|abdominal]]/groin/[[Special:MyLanguage/testicular Pain|testicular Pain]]
*+/- signs/symptoms of [[SBO]], [[peritonitis]] if strangulated
*+/- signs/symptoms of [[Special:MyLanguage/SBO|SBO]], [[Special:MyLanguage/peritonitis|peritonitis]] if strangulated
 


==Differential Diagnosis==
==Differential Diagnosis==
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{{Template:Testicular DDX}}
{{Template:Testicular DDX}}
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==Evaluation==
==Evaluation==
[[File:Hernia Locations.jpeg|thumb]]
[[File:Hernia Locations.jpeg|thumb]]
===Work-Up===
===Work-Up===
*Labs
*Labs
**Not routinely necessary
**Not routinely necessary
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**CT, if concern for obstruction/strangulation
**CT, if concern for obstruction/strangulation
**Ultrasound (only indicated to exclude other diagnoses)
**Ultrasound (only indicated to exclude other diagnoses)


===Diagnosis===
===Diagnosis===


==Management==
==Management==
*Reduction for incarcerated hernia
*Reduction for incarcerated hernia
**If there is any concern for strangulation, do not attempt hernia reduction
**If there is any concern for strangulation, do not attempt hernia reduction
***Reintroduction of ischemic bowel back into peritoneal cavity can result in sepsis
***Reintroduction of ischemic bowel back into peritoneal cavity can result in sepsis
**NPO (in case reduction unsuccessful)
**NPO (in case reduction unsuccessful)
**IV [[opioid]] analgesia
**IV [[Special:MyLanguage/opioid|opioid]] analgesia
**Supine and mild Trendelenburg positioning
**Supine and mild Trendelenburg positioning
**Apply cold packs to hernia site to reduce swelling
**Apply cold packs to hernia site to reduce swelling
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**If successful observe patient in ED period of time for serial abdominal exams
**If successful observe patient in ED period of time for serial abdominal exams
**If unsuccessful after 1 or 2 attempts consult surgery
**If unsuccessful after 1 or 2 attempts consult surgery
*Antibiotics (e.g. [[Cefoxitin]]) for
*Antibiotics (e.g. [[Special:MyLanguage/Cefoxitin|Cefoxitin]]) for
**[[Bowel obstruction]]
**[[Special:MyLanguage/Bowel obstruction|Bowel obstruction]]
**[[Peritonitis]]
**[[Special:MyLanguage/Peritonitis|Peritonitis]]
 


==Disposition==
==Disposition==
*Discharge with surgery referral:
*Discharge with surgery referral:
**Easily reducible hernia
**Easily reducible hernia
**Spigelian, femoral, obturator, Richter hernias (all have high rates of incarceration)
**Spigelian, femoral, obturator, Richter hernias (all have high rates of incarceration)


==See Also==
==See Also==
*[[Inguinal Hernia (Peds)]]
 
*[[Testicular Diagnoses]]
*[[Special:MyLanguage/Inguinal Hernia (Peds)|Inguinal Hernia (Peds)]]
*[[Special:MyLanguage/Testicular Diagnoses|Testicular Diagnoses]]
 


==References==
==References==
<references/>
<references/>




[[Category:GI]]
[[Category:GI]]
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Revisión actual - 23:05 4 ene 2026


This page is for adult patients. For pediatric patients, see: 

inguinal hernia (peds)

Background

Scrotal anatomy
Anatomy of an inguinal hernia.

Classification

  • Reducible
    • Hernia sac soft, easy to replace back through the hernia defect
  • Incarcerated
    • Hernia sac firm, often painful, nonreducible
  • Strangulation
    • Impairment of blood flow
    • Severe pain at hernia site
    • Signs of intestinal obstruction
    • Skin changes overlying hernia sac may be seen


Types

  • Inguinal (75%)
    • Most common type of hernia in both men and women
    • Presents as groin mass
    • Indirect (50%)
      • Hernia passes from inguinal ring into scrotum (due to patent processus vaginalis)
    • Direct (25%)
      • Hernia passes directly through transversalis fascia in Hesselbach triangle
  • Ventral
    • Due to defect in anterior abdominal wall (spontaneous or acquired)
    • Incisional
      • Due to excess wall tension or inadequate wound healing / surgical wound infection
    • Umbilical
      • Due to conditions that increase intra-abdominal pressure (ascites, pregnancy, obesity)
      • May ulcerate from ascites, see Flood Syndrome
    • Spigelian
      • Also known as lateral ventral hernia
      • Nearly always acquired conditions
      • Difficult to diagnose
        • Classic presentation is abdominal pain associated with anterior lateral abdominal wall mass
        • Physical exam is unreliable; imaging (US or CT) is often required
  • Femoral
    • 10:1 female:male ratio
    • Hernia sac protrudes through femoral canal
    • Mass is typically below the inguinal ring
    • Particularly prone to complications
  • Obsturator
    • Bowel herniation through obturator canal
    • Nearly always presents as partial or complete bowel obstruction
    • High complication rate
  • Richter
    • Involves only antimesenteric border of intestine and only portion of the wall
    • Often presents with out vomiting or intestinal obstruction
      • As a result, more likely to diagnose once wall has begun to become ischemic


Clinical Features

Adult male right-sided with inguinal hernia.
Inguinal hernia.JPG
Hernia umilicalis.jpg
  • Hernia (usually) palpable on exam
    • If incarcerated, nonreducible
    • If strangulated, nonreducible and may have overlying skin changes
  • +/- abdominal/groin/testicular Pain
  • +/- signs/symptoms of SBO, peritonitis if strangulated


Differential Diagnosis

Testicular Diagnoses


Evaluation

Hernia Locations.jpeg

Work-Up

  • Labs
    • Not routinely necessary
    • Consider CBC, chemistry, lactate if concern for strangulation
  • Imaging
    • CT, if concern for obstruction/strangulation
    • Ultrasound (only indicated to exclude other diagnoses)


Diagnosis

Management

  • Reduction for incarcerated hernia
    • If there is any concern for strangulation, do not attempt hernia reduction
      • Reintroduction of ischemic bowel back into peritoneal cavity can result in sepsis
    • NPO (in case reduction unsuccessful)
    • IV opioid analgesia
    • Supine and mild Trendelenburg positioning
    • Apply cold packs to hernia site to reduce swelling
    • Apply firm, steady pressure to distal part of hernia
    • If successful observe patient in ED period of time for serial abdominal exams
    • If unsuccessful after 1 or 2 attempts consult surgery
  • Antibiotics (e.g. Cefoxitin) for


Disposition

  • Discharge with surgery referral:
    • Easily reducible hernia
    • Spigelian, femoral, obturator, Richter hernias (all have high rates of incarceration)


See Also


References

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