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The important locations for hernia in the patient with groin pain are the inguinal and femoral canals. Within the inguinal canal, there are two types of hernia, indirect and direct. An indirect hernia is one that travels along the length of the inguinal canal. and indirect hernia enters the canal via the deep ring and travelled medially along the canal itself emerging, it's long enough, from the external ring. A direct hernia is one that enters the canal through a week or defective posteriorly and then travels along the canal either in the medial or lateral direction. The particular characteristics of an indirect inguinal hernia are therefore

  • enters via the internal ring
  • begins lateral to the epigastric artery
  • travel is parallel to the inguinal cana


At rest, hernias can be either reducible or irreducible. And irreducible hernia is one that is present within the Kanow at all times. Reducible hernia, the more common in younger individuals, is one that is only present when there is an increasing abdominal pressure. Dynamic imaging is therefore required to diagnose this common type. The dynamic imaging used is most often ultrasound. Dynamic MR imaging during Valsalva manoeuvre can also be used but it is more difficult to produce a reliable Valsalva using MR. The ultrasonologist however can feel whether the patient is performing the manoeuvre correctly and therefore ultrasound provides a more reliable true negative test The ultrasound technique therefore is to locate the internal ring and inguinal canal with the patient relaxed. The patient is then encouraged to perform some form of strain manoeuver. The competency of this is best assessed without ultrasound probe in hand and the patient should be encouraged to practice until there is clear cut evidence that a high pressure strain is being performed. Once the dynamic manoeuve has been successfully taught, the probe is placed parallel to the inguinal canal. If an indirect hernia is present, a mass seem to enter via the internal ring and travel along the canal. The ma bowel but more often comprises omental fat.
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