Role of Imaging in the Diagnosis of Occult Hernias

Abstract

Inguinal hernia is a common cause of groin or pelvic pain that responds well to surgical repair.¹ Although patients who would benefit from herniorrhaphy often have a reducible mass or palpable defect on physical examination, the absence of such a finding does not rule out a hernia. A “hidden hernia” is a clinically significant occult hernia wherein physical examination fails to demonstrate a reducible mass or defect, but a hernia is identified on surgical exploration.² Although a hernia repair resolves the patient’s presenting symptoms,³ surgical exploration of every patient with groin or pelvic pain would result in unnecessary procedures. A more definitive diagnosis of hidden hernia requires imaging as part of the workup to confirm the clinical suspicion; this may include ultrasonography (US) of the groin, computed tomography (CT) of the pelvis, and/or magnetic resonance imaging (MRI) of the pelvis.