Diagnosis

The diagnosis of a hernia is a clinical diagnosis based on the patient's symptoms and physical exam, rarely are any confirmatory studies required. Symptoms include vague discomfort, pain, fullness or a bulge. Extreme pain can occur with incarceration.

Physical examination includes inspection and palpation in both the supine and standing positions. A Valsalva maneuver or cough can also help in the detection of a hernia. Determination of whether a hernia is direct or indirect based on physical exam is usually unreliable. During examination an incarcerated hernia may be reduced with gentle pressure. Attempts at reduction should be abandoned if evidence of strangulation is present or if reduction would require undue force that might damage the contents of the hernia sac.

A femoral hernia presents as a bulge below the inguinal ligament. These hernias have a higher incidence of strangulation (22% at 3 months) than inguinal hernias (2.8% at 3 months). Incarcerated femoral hernias may also present with a bruit over the femoral vein.

Hydroceles can be differentiated from inguinal hernias by translumination. Only rarely are ultrasound, computed tomography, magnetic resonance imaging, or herniography needed to confirm the presence of a hernia.

An obturator hernia may present with a palpable mass on rectal or pelvic exam. One-half of these patients will present with pain in the hip extending down the medial thigh to the knee (Howship-Romberg sign).

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