Classification, clinical features, and diagnosis of inguinal and femoral hernias in adults

Classification, clinical features, and diagnosis of inguinal and femoral hernias in adults - UpToDate 12/26/17, 9)27 AM Official reprint from UpToDateđ www.uptodate.com â2017 UpToDate, Inc and/or its affiliates All Rights Reserved Classification, clinical features, and diagnosis of inguinal and femoral hernias in adults Authors: David C Brooks, MD, Mary Hawn, MD Section Editor: Michael Rosen, MD Deputy Editor: Wenliang Chen, MD, PhD All topics are updated as new evidence becomes available and our peer review process is complete Literature review current through: Nov 2017 | This topic last updated: Jun 21, 2017 INTRODUCTION — Hernias are among the oldest recorded afflictions of mankind A hernia is defined as a protrusion, bulge, or projection of an organ or a part of an organ through the body wall that normally contains it Collectively, inguinal and femoral hernias are known as groin hernias Inguinal hernia is more common than femoral hernia and other abdominal wall hernias (eg, umbilical, epigastric), but femoral hernias present with complications more often [1] The classification, epidemiology, clinical features, and diagnosis of inguinal and femoral hernias will be reviewed The management of groin hernias (nonsurgical and surgical) is discussed elsewhere (See "Overview of treatment for inguinal and femoral hernia in adults" and "Open surgical repair of inguinal and femoral hernia in adults" and "Laparoscopic inguinal and femoral hernia repair in adults".) Inguinal hernias in children and abdominal wall hernias are reviewed separately (See "Inguinal hernia in children" and "Overview of abdominal wall hernias in adults".) EPIDEMIOLOGY — Groin hernias (inguinal or femoral hernias) were the third leading cause of ambulatory care visits for gastrointestinal complaints in 2004, and visit rates have not changed appreciably since 1975 [2] The prevalence of groin hernias is estimated to be between and 10 percent in the United States Inguinal hernia is more common than femoral hernia and other abdominal wall hernias (eg, umbilical, epigastric) [1] Although femoral hernias account for less than 10 percent of groin hernias, they present clinically with complications (incarceration, strangulation) more often than inguinal hernias (See 'Clinical features' below.) Hernias are more common in men compared with women and in whites compared with non-whites [2,3] Men are eight times more likely to develop a hernia and 20 times more likely to need a hernia repair compared with women [4,5] The lifetime risk of developing a groin hernia is approximately 25 percent in men but less than percent in women Women manifest groin hernias at a later age In one review, the median age at presentation was 60 to 79 years of age for women compared with 50 to 69 years of age for men [6] The peak age range at presentation for indirect hernia in women is 40 to 60 years of age [6] (See 'Clinical features' below.) Groin hernias are classified anatomically as inguinal (indirect or direct) or femoral (see 'Anatomic location' https://www.uptodate.com/contents/classification-clinical-features-a…nt?search=inguinal%20hernia&source=search_result&selectedTitle=2~100 Page of 22 Classification, clinical features, and diagnosis of inguinal and femoral hernias in adults - UpToDate 12/26/17, 9)27 AM below) In clinical reviews: ● Approximately 96 percent of groin hernias are inguinal and percent are femoral [7] ● Indirect inguinal hernia is the most common groin hernia in both sexes [6,8,9] In the Swedish registry, indirect inguinal hernia accounted for 49 percent of repairs in women and 54 percent in men [9] ● Direct inguinal hernia accounts for 30 to 40 percent of groin hernias in men [9] but approximately 14 to 21 percent of groin hernias in women [6,8,9] ● Femoral hernias account for