eMedicine Specialties > Emergency Medicine > Gastrointestinal

Hernias: Differential Diagnoses & Workup

Author: Bret A Nicks, MD, Assistant Professor, Assistant Medical Director, Department of Emergency Medicine, Wake Forest University Health Sciences
Coauthor(s): Kim Askew, MD, Assistant Professor, Department of Emergency Medicine, Wake Forest University School of Medicine
Contributor Information and Disclosures

Updated: Nov 11, 2009

Differential Diagnoses

Epididymitis
Hidradenitis Suppurativa
Hydrocele
Lymphogranuloma Venereum
Testicular Torsion

Other Problems to Be Considered

Groin abscess
Hematoma
Lipoma
Lymphadenitis
Pseudoaneurysm
Spermatocele
Tumor
Undescended or retracted testes
Varicocele

Workup

Laboratory Studies

  • Complete blood count
    • Results from CBC are nonspecific.
    • Leukocytosis with left shift may occur with strangulation.
  • Electrolytes, BUN, creatinine levels
    • Assess the hydration status of the patient with nausea and vomiting.
    • These tests are rarely needed for patients with hernia except as part of a preoperative workup.
  • Urinalysis: This test assists with narrowing the differential diagnosis of genitourinary causes of groin pain in the setting of associated hernias.

Imaging Studies

  • Imaging studies are not required in the normal workup of a hernia.4,6
  • Ultrasonography can be used in differentiating masses in the groin or abdominal wall or in differentiating testicular sources of swelling.
  • If an incarcerated or strangulated hernia is suspected, the following imaging studies can be performed:
    • Upright chest radiograph to exclude free air (extremely rare)
    • Flat and upright abdominal films to diagnose a small bowel obstruction (neither sensitive or specific) or to identify areas of bowel outside the abdominal cavity
  • CT scanning or ultrasonography may be necessary in the following cases:
    • To diagnose a spigelian or obturator hernia
    • Inability to obtain a good examination because of body habitus

More on Hernias

Overview: Hernias
Differential Diagnoses & Workup: Hernias
Treatment & Medication: Hernias
Follow-up: Hernias
Multimedia: Hernias
References
[ CLOSE WINDOW ]

References

  1. Eubanks S. Hernias. In: Sabiston DC Jr, ed. Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 1997.

  2. Katz DA. Evaluation and management of inguinal and umbilical hernias. Pediatr Ann. Dec 2001;30(12):729-35. [Medline].

  3. Levine BJ, Nabha S, Bouzoukis JK. Chronic inguinal hernia. J Emerg Med. May-Jun 1999;17(3):515-6. [Medline].

  4. Matthews RD, Neumayer L. Inguinal hernia in the 21st century: an evidence-based review. Curr Probl Surg. Apr 2008;45(4):261-312. [Medline].

  5. Scherer LR 3d, Grosfeld JL. Inguinal hernia and umbilical anomalies. Pediatr Clin North Am. Dec 1993;40(6):1121-31. [Medline].

  6. Bobrow RS. The hernia. J Am Board Fam Pract. Jan-Feb 1999;12(1):95-6. [Medline].

  7. Wants GE. Abdominal wall hernias. In: Schwartz SI, Shires GT, Spencer FC, eds. Principles of Surgery. 6th ed. 1994.

  8. Mensching JJ, Musielewicz AJ. Abdominal wall hernias. Emerg Med Clin North Am. Nov 1996;14(4):739-56. [Medline].

  9. Manthey DE. Abdominal hernia reduction. In: Clinical Procedures in Emergency Medicine. 2003.

  10. Brandt ML. Pediatric hernias. Surg Clin North Am. Feb 2008;88(1):27-43, vii-viii. [Medline].

  11. Rutkow IM, Robbins AW. Demographic, classificatory, and socioeconomic aspects of hernia repair in the United States. Surg Clin North Am. Jun 1993;73(3):413-26. [Medline].

  12. Rutkow IM. Epidemiologic, economic, and sociologic aspects of hernia surgery in the United States in the 1990s. Surg Clin North Am. Dec 1998;78(6):941-51, v-vi. [Medline].

  13. Kapur P, Caty MG, Glick PL. Pediatric hernias and hydroceles. Pediatr Clin North Am. Aug 1998;45(4):773-89. [Medline].

  14. Akbulut S, Cakabay B, Sezgin A. A familial tendency for developing inguinal hernias: study of a single family. Hernia. Aug 29 2009;[Medline].

  15. Smith S. Inguinal hernia reduction. In: King C, Henretig FM, eds. Textbook of Pediatric Emergency Procedures. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2008:840-847/87.

  16. Ginsburg BY, Sharma AN. Spontaneous rupture of an umbilical hernia with evisceration. J Emerg Med. Feb 2006;30(2):155-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

hernia, hernia symptoms, hernia treatment, hernia causes, abdominal wall hernia, indirect inguinal hernia, indirect hernia, direct inguinal hernia, direct hernia, femoral hernia, umbilical hernia, Richter hernia, incisional hernia, spigelian hernia, obturator hernia, reducible hernia, incarcerated hernia, strangulated hernia

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Bret A Nicks, MD, Assistant Professor, Assistant Medical Director, Department of Emergency Medicine, Wake Forest University Health Sciences
Bret A Nicks, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Christian Medical & Dental Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Kim Askew, MD, Assistant Professor, Department of Emergency Medicine, Wake Forest University School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard Lavely, MD, JD, MS, MPH, Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine
Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eugene Hardin, MD, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.