Patients frequently present to the emergency department with a complaint of groin pain. There may or may not be a history of heavy lifting. In males, palpation of the inguinal canal is easily performed by inversion of scrotal skin and passage of a digit through the external ring. Voluntary increase in intraabdominal pressure during this examination reliably detects most inguinal hernias. With the tip of the digit near the internal ring, a tapping sensation is detected at Valsalva or cough. In females, the external ring is generally narrower and the skin of the labium majora is not easily inverted, making introduction of a digit difficult. Therefore, failure to palpate a hernial sac in women is not foolproof.
Groin hernias have a larger number of differential diagnostic possibilities ( Table„ZB:2). They most commonly are confused with tender lymph nodes and hydroceles. Lymph nodes are generally movable, firm, and multiple. Hydroceles may transilluminate and are not tender. Incarcerated hernias will not transilluminate and are tender. If bowel is contained in the hernia sac, bowel sounds may be heard and peristalsis may be seen. In children, retractile or undescended testes may be mistaken for hernias. Testicular torsion or tumor may be confused with incarcerated hernias.
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