Differentiation Between Groin Hernia With Cross-Sectional Imaging

The sectional imaging of groin hernia poses a problem to the inexperienced operator due to intricate anatomy of the region. Inguinal and femoral hernias are the usual defects with a prevalence rate of 5% or more. Inguinal hernias comprise approximately 75% of all hernias, of which two-thirds are indirect and one-third are direct. Femoral hernia represent 3% of hernias. Although both types may be incarcerated and strangulated, the risk is higher for the femoral type (20%25% vs. 3%). Current surgical information still indicates that indirect inguinal and femoral hernias require surgery as they are at higher risk for complications. As surgical approach differs in inguinal and femoral hernias, the ability to differentiate different hernias is both in the interest of the patient and the clinician. The aim of our study is to propose reliable guidelines for distinguishing three types of groin hernias with combined planes of CT to help radiologists better assist the clinicians in accurate diagnosis. In all articles which we reviewed, identification of pelvic anatomic structures, location of each type of groin hernia in relation to important CT landmarks (such as inferior epigastric artery and pubic tubercle,...), and also key findings in each type of hernia have been investigated. We first explain schematic anatomic structures in axial, coronal and sagittal planes of contrast-enhanced CT and then introduce easy and reliable guidelines to approach the groin hernias.