Name the hernia by its neck (inguinal, femoral, incisional, spigelian, obturator), measure the neck and the sac, and look for the complications — obstruction, incarceration, strangulation — that make it an emergency.
Orient first
- Inguinal: direct (medial to the inferior epigastric vessels) vs indirect (lateral, along the cord).
- Femoral hernias lie below the inguinal ligament, medial to the femoral vein, and strangulate often.
- Obturator and spigelian hernias are small and easily missed; strangulation shows as a closed loop.
Acquire the study
- Portal venous phase, thin slices with sagittal and coronal reformats; Valsalva series if the hernia is not seen at rest.
The manoeuvre
- Locate the neck relative to landmarks (inferior epigastric vessels, femoral vein, linea semilunaris, obturator canal).
- Measure the neck width in cm and the sac contents.
- Obstruction: dilated bowel proximal to the hernia with collapsed distal bowel.
- Strangulation: reduced wall enhancement, fluid in the sac, mesenteric stranding.
What confirms it
- A defect with herniated contents, named by its neck.
What licenses you to exclude it
- No defect at rest and with Valsalva excludes a hernia at that site on this study.
The classic misread
- Missing a small obturator hernia between pectineus and obturator externus.