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Inguinal Hernia


Parswa Ansari

, MD, Hofstra Northwell-Lenox Hill Hospital, New York

Last full review/revision Sep 2021| Content last modified Sep 2021
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An inguinal hernia is a protrusion of the abdominal contents through an acquired or congenital area of weakness or defect in the abdominal wall just above the inguinal ligament. Many inguinal hernias are asymptomatic, but some become incarcerated or strangulated, causing pain and requiring immediate surgery. Diagnosis is clinical. Treatment is elective surgical repair.

Classification of Inguinal Hernia

Inguinal hernias occur above the inguinal ligament. They can be

  • Indirect: Traversing the internal inguinal ring into the inguinal canal

  • Direct: Extending directly forward and not passing through the inguinal canal

Symptoms and Signs of Inguinal Hernia

Most patients complain only of a visible bulge, which may cause vague discomfort or be asymptomatic. Most hernias, even large ones, can be manually reduced with persistent gentle pressure; placing the patient in the Trendelenburg position may help.

An incarcerated hernia cannot be reduced and can be the cause of a bowel obstruction.

A strangulated hernia causes steady, gradually increasing pain, typically with nausea and vomiting. The hernia itself is tender, and the overlying skin may be erythematous; peritonitis may develop depending on location, with diffuse tenderness, guarding, and rebound.

Diagnosis of Inguinal Hernia

  • Clinical evaluation

The diagnosis of an inguinal hernia is clinical. Because the hernia may be apparent only when abdominal pressure is increased, the patient should be examined in a standing position. If no hernia is palpable, the patient should cough or perform a Valsalva maneuver as the examiner palpates the groin (with a finger in the inguinal canal in males).

Treatment of Inguinal Hernia

  • Surgical repair

Inguinal hernias typically should be repaired electively because of the risk of strangulation, which results in higher morbidity (and possible mortality in older patients). Asymptomatic inguinal hernias in men can be observed; if symptoms develop, they can be repaired electively. Repair may be through a standard incision or laparoscopically.

An incarcerated or strangulated hernia of any kind requires urgent surgical repair.

Key Points

  • Inguinal hernias can be direct or indirect.

  • Manifestations of strangulation include increasing pain and tenderness, sometimes erythema; peritonitis may follow.

  • Do elective surgical repair to avoid strangulation and urgent surgery.

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