Usefulness of Computed Tomography for Differentiation of Primary Inguinal Hernia

  • Mustafa Hasbahceci Bezmialem Vakif University Faculty of Medicine Dept of General Surgery
  • Cengiz Erol İstanbul medipol university faculty of medicine dept of radiology
Keywords: Hernia, inguinal, diagnosis, imaging, computed tomography.


 Objective: The perception of inguinal anatomy during hernia formation may be an important issue for the evaluation of hernias. This study was conducted to describe detailed anatomy of inguinal region in patients with primary inguinal hernia by using computed tomography.Methods: Study group included 18 inguinal hernia patients with computed tomography images. Images with multi-planar reformatting were evaluated with regard to anatomical landmarks found in inguinal region. Results: Visualization of inguinal ligament and inferior epigastric artery was possible in all patients. Type of inguinal hernia was defined correctly in all patients by using inferior epigastric artery as an anatomic landmark. Pubic tubercle and lateral crescent sign in differentiation between direct and indirect inguinal hernias had variable sensitivity and specificity (0.69 and 0.60 for pubic tubercle, and 0.69 and 0.80 for lateral crescent sign, respectively). Conclusion: Multi-planar reformatting helps physicians to differentiate types of inguinal hernia by using the inferior epigastric artery as an anatomic landmark. 


Delabrousse E, Denue PO, Aubry S, Sarliève P, Mantion GA, Kastler BA. The pubic tubercle: a CT landmark in groin hernia. Abdom Imaging 2007; 32: 803-6.

Yeung VH, Pearl JM, Coakley FV, Joe BN, Westphalen AC, Yeh BM. Computed tomographic appearance of Prolene Hernia System and polypropylene mesh plug inguinal hernia repair. J Comput Assist Tomogr 2008; 32: 529-32.

Holzheimer RG. Inguinal hernia repair: what to do with the evidence? World J Surg 2009 33:2056-7.

Cherian PT, Parnell AP. The diagnosis and classification of inguinal and femoral hernia on multisection spiral CT. Clin Radiol 2008; 63: 184-92.

Suzuki S, Furui S, Okinaga K, Sakamoto T, Murata J, Furukawa A, et al. Differentiation of femoral versus inguinal hernia: CT findings. AJR Am J Roentgenol 2007; 189: W78-83.

Garvey JF. Computed tomography scan diagnosis of occult groin hernia (2012) Hernia 16:307-14.

Burkhardt JH, Arshanskiy Y, Munson JL, Scholz FJ. Diagnosis of inguinal region hernias with axial CT: the lateral crescent sign and other key findings. Radiographics 2011; 31: E1-12.

Kitami M, Takase K, Tsuboi M, Rikimaru Y, Hakamatsuka T, Yamada T, et al. Differentiation of femoral and inguinal hernias on the basis of anteroposterior relationship to the inguinal ligament on multidimensional computed tomography. J Comput Assist Tomogr 2009; 33:678-81.

Hoshiai S, Mori K, Shiigai M, et al (2014) Reduction en masse of inguinal hernia: MDCT findings of two cases. Hernia 2014 Jan 12. doi 10.1007/s10029-014-1217-9

Robinson A, Light D, Kasim A, Nice C. A systematic review and meta-analysis of the role of radiology in the diagnosis of occult inguinal hernia. Surg Endosc 2012; 27: 11-8.

Fataar S. CT of inguinal canal lipomas and fat-containing inguinal hernias. J Med Imaging Radiat Oncol 2011; 55: 485-92.

Cherian PT, Parnell AP. Radiologic anatomy of the inguinofemoral region: insights from CT. AJR Am J Roentgenol 2007; 189: W177-83.

Shizukuishi T, Abe K, Takahashi M, Sakaguchi M, Aizawa T, Narata M, et al. Inguinal bladder hernia: multi-planar reformation and 3-D reconstruction computed tomography images useful for diagnosis. Nephrology (Carlton) 2009; 14: 263.

Højer AM, Rygaard H, Jess P. CT in the diagnosis of abdominal wall hernias: a preliminary study. Eur Radiol 1997; 7: 1416-8.

Emby DJ, Aoun G. CT technique for suspected anterior abdominal wall hernia. AJR Am J Roentgenol. 2003; 181: 431-3.

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