Diagnosis of a Lump in the Adult Groin

  • Andrew C. de Beaux
  • Dilip Patel


Swelling and pain in the groin are a common presentation for the abdominal surgeon. Nevertheless, diagnosis of a problem in the groin can still, in some cases, be a difficult clinical dilemma. It is fair to say that the diagnosis of an obvious swelling in the groin is usually straightforward, in terms of a hernia being present or not. However, the traditional inguinoscrotal hernia, where the hernial sac passes down into the scrotum, is a relatively uncommon event. Coupled with the increasing body mass index of the population, it is increasingly common for even a large groin hernia not to result in an obvious groin swelling. In some cases, where there is diagnostic doubt, thinking about several key questions may focus the investigation pathway:
  • Groin symptoms but no swelling, is there a hernia?

  • Groin swelling, but is it a hernia?

  • Hernia, but is it causing the symptoms?


  1. 1.
    Hair A, Paterson C, Wright D, Baxter JN, O’Dwyer PJ. What effect does the duration of an inguinal hernia have on patient symptoms? J Am Coll Surg. 2001;193:125–9.CrossRefGoogle Scholar
  2. 2.
    Chung L, Norrie J, O’Dwyer PJ. Long-term follow-up of patients with a painless inguinal hernia from a randomized trial. Br J Surg. 2011;98:596–9.CrossRefGoogle Scholar
  3. 3.
    Smith GD, Crsoby DL, Lewis PA. Inguinal hernia and a single stressful event. Ann R Coll Surg Engl. 1996;78:367–8.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Pathak S, Poston GJ. It is highly unlikely that the development of an abdominal wall hernia can be attributable to a single strenuous event. Ann R Coll Surg Engl. 2006;88:168–71.CrossRefGoogle Scholar
  5. 5.
    Schofield PF. Inguinal hernia: medicolegal implications. Ann R Coll Surg Engl. 2000;82:109–10.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Hair A, Paterson C, O’Dwyer PJ. Diagnosis of a femoral hernia in the elective setting. J R Coll Surg Edinb. 2001;46:117–8.PubMedGoogle Scholar
  7. 7.
    Harissis HV, Douitsis E, Fatouros M. Incarcerated hernia: to reduce or not to reduce. Hernia. 2009;13:263–6.CrossRefGoogle Scholar
  8. 8.
    Derici H, Unalp HR, Bozdaq AD. Factors affecting morbidity and mortality in incarcerated abdominal wall hernia. Hernia. 2007;11:341–6.CrossRefGoogle Scholar
  9. 9.
    Kemler MA, Oostvogel HJM. Femoral hernia: is a conservative policy justified? Eur J Surg. 1997;163:187–90.PubMedGoogle Scholar
  10. 10.
    Horn TW, Harris JA, Martindale R, Gadacz T. When a hernia is not a hernia: the evaluation of inguinal hernias in the cirrhotic patient. Am Surg. 2001;67:1093–5.PubMedGoogle Scholar
  11. 11.
    Fawcett AN, Rooney PS. Inguinal canal lipoma. Br J Surg. 1997;84:1169–70.CrossRefGoogle Scholar
  12. 12.
    Read RC, White HJ. Lipoma of the spermatic cord, fatty herniation, liposarcoma. Hernia. 2000;4:149–54.CrossRefGoogle Scholar
  13. 13.
    Sozutek A, Irkorucu O, Reyhan E, et al. A giant aggressive angiomyxoma of the pelvis misdiagnosed as incarcerated femoral hernia: a case report and review of the literature. Case Rep Surg. 2016;2016:1–6.CrossRefGoogle Scholar
  14. 14.
    Valeshabad AK, et al. An important mimic of inguinal hernia. Urology. 2016;97:e11.CrossRefGoogle Scholar
  15. 15.
    Buchs NC, Bloemendaal AL, Guy RJ. Localized peritoneal carcinomatosis mimicking an irreducible left inguinal hernia. Ann R Coll Surg Engl. 2016;98(3):e52–4.CrossRefGoogle Scholar
  16. 16.
    Sarkar S, Panja S, Kumar S. Hydrocele of the canal of Nuck (female hydrocele): a rare differential for inguinal-labial swelling. J Clin Diagn Res. 2016;10(2):PD21–2.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Pandey D, Coondoo A, Shetty J, Mathew S. Jack in the box: inguinal endometriosis. BMJ Case Rep. 2015;2015.
  18. 18.
    Henriksen NA, Bisgaard Thorup J, Jorgensen LN. Unsuspected femoral hernia in patients with a prospective diagnosis of recurrent inguinal hernia. Hernia. 2012;16:381–5.CrossRefGoogle Scholar
  19. 19.
    Ashby EC. Chronic obscure groin pain is commonly caused by enthesopathy: ‘tennis elbow’ of the groin. Br J Surg. 1994;81:1632–4.CrossRefGoogle Scholar
  20. 20.
    Macleod DAD, Gibbon WW. The sportsman’s groin. Br J Surg. 1999;86:849–50.CrossRefGoogle Scholar
  21. 21.
    Eames NWA, Deans GT, Lawson JT, Irwin ST. Herniography for occult hernia and groin pain. Br J Surg. 1994;81:1529–30.CrossRefGoogle Scholar
  22. 22.
    Allen RP, Condon VR. Transitory extraperitoneal hernia of the bladder in infants (bladder ears). Radiology. 1961;77:979–83.CrossRefGoogle Scholar
  23. 23.
    Sternhill B, Schwartz S. Effect of hypaque on mouse peritoneum. Radiology. 1960;75:81–4.CrossRefGoogle Scholar
  24. 24.
    Ducharme JC, Bertrand R, Chacar R. Is it possible to diagnose inguinal hernia by x-ray? J Can Assoc Radiol. 1967;18:448.PubMedGoogle Scholar
  25. 25.
    Gullmo A. Herniography. World J Surg. 1989;13:560–8.CrossRefGoogle Scholar
  26. 26.
    Hamlin JA, Kahn AM. Herniography in symptomatic patients following inguinal hernia repair. West J Med. 1995;162:28–31.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Harrison LA, Keesling CA, Martin NL, Lee KR, Wetzel LH. Abdominal wall hernias: review of herniography and correlation with cross-sectional imaging. Radiographics. 1995;15:315–32.CrossRefGoogle Scholar
  28. 28.
    Hachem MI, Saunders MP, Rix TE, Anderson HJ. Herniography: a reliable investigation avoiding needless groin exploration—a retrospective study. Hernia. 2009;13:57–60.CrossRefGoogle Scholar
  29. 29.
    MacArthur DC, Grieve DC, Thompson JD, Greig JD, Nixon SJ. Herniography for groin pain of uncertain origin. Br J Surg. 1997;84:684–5.CrossRefGoogle Scholar
  30. 30.
    Heise CP, Sproat IA, Starling JR. Peritoneography (herniography) for detecting occult inguinal hernia in patients with inguinodynia. Ann Surg. 2002;235:140–4.CrossRefGoogle Scholar
  31. 31.
    Djuric-Stefanovic A, Saranovic D, Ivanovic A, et al. The accuracy of ultrasonography in classification of groin hernias according to the criteria of the unified classification system. Hernia. 2008;12:395–400.CrossRefGoogle Scholar
  32. 32.
    Depasquale R, Landes C, Doyle G. Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained. Clin Radiol. 2009;64:608–14.CrossRefGoogle Scholar
  33. 33.
    Gupta H, Subedi N, Robinson P. Effectiveness of sonography in detecting clinically occult femoral hernias. J Ultrasound Med. 2016;35:1675–9.CrossRefGoogle Scholar
  34. 34.
    Lawrenz K, Hollman AS, Carachi R, Cacciagnerra S. Ultrasound assessment of the contralateral groin in infants with unilateral inguinal hernia. Clin Radiol. 1994;49:546–8.CrossRefGoogle Scholar
  35. 35.
    Kawaguchi AL, Shaul DB. Inguinal hernias can be accurately diagnosed using the parent’s digital photographs when the physical examination is nondiagnostic. J Pediatr Surg. 2009;44:2327–9.CrossRefGoogle Scholar
  36. 36.
    Chen KC, Chu CC, Chou TY, Wu CJ. Ultrasound for inguinal hernias in boys. J Pediatr Surg. 1999;34:1890–1.CrossRefGoogle Scholar
  37. 37.
    Zhang GQ, Sugiyama M, Hagi H, Urata T, Shimamori N, Atomi Y. Groin hernias in adults; value of colour Doppler sonography in their classification. J Clin Ultrasound. 2001;29:429–34.CrossRefGoogle Scholar
  38. 38.
    Lee RK, Griffith JF, Ng WH. High accuracy of ultrasound in diagnosing the presence and type of groin hernia. J Clin Ultrasound. 2015;43:538–47.CrossRefGoogle Scholar
  39. 39.
    Jacobson JA, Khoury V, Brandon CJ. Ultrasound of the groin: techniques, pathology and pitfalls. Am J Roentgenol. 2015;205:513–23.CrossRefGoogle Scholar
  40. 40.
    Cherian PT, Parnell AP. The diagnosis and classification of inguinal and femoral hernia on multisection spiral CT. Clin Radiol. 2008;63:184–92.CrossRefGoogle Scholar
  41. 41.
    Kitami M, Takase K, Tsuboi M, et al. Differentiation of femoral and inguinal hernias on the basis of anteroposterior relationship to the inguinal ligament on multidimensional computed tomography. J Comput Assist Tomogr. 2009;33:678–81.CrossRefGoogle Scholar
  42. 42.
    Hahn-Pederson J, Lund L, Hansen-Hojhus J, Bojsen-Muller F. Evaluation of direct and indirect inguinal hernia by computed tomography. Br J Surg. 1994;81:569–72.CrossRefGoogle Scholar
  43. 43.
    Garvey JF. Computed tomography scan diagnosis of occult groin hernia. Hernia. 2012;16:307–14.CrossRefGoogle Scholar
  44. 44.
    Omar IM, Zoga AC, Kavanagh EC, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28:1415–38.CrossRefGoogle Scholar
  45. 45.
    Barile A, Erriquez D, Cacchio A, DePaulis F, Di Cesare E, Masciocchi C. Groin pain in athletes: role of magnetic resonance. Radiol Med. 2000;100:216–22.PubMedGoogle Scholar
  46. 46.
    Leander P, Ekberg O, Sjoberg S, Kesek P. MR imaging following herniography in patients with unclear groin pain. Eur Radiol. 2000;10:1691–6.CrossRefGoogle Scholar
  47. 47.
    Robinson A, Light D, Kasim A, Nice C. A systematic review and meta-analysis of the role of radiology in the diagnosis of occult inguinal hernia. Surg Endosc. 2013;27:11–8.CrossRefGoogle Scholar
  48. 48.
    Miller J, Cho J, Michael MJ, Saouaf R, Towfigh S. Role of imaging in the diagnosis of occult hernias. JAMA Surg. 2014;149:1077–80.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General SurgeryRoyal Infirmary of EdinburghEdinburghUK
  2. 2.Department of RadiologyRoyal Infirmary of EdinburghEdinburghUK

Personalised recommendations