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In Swedish practice, an inguinal bulge is evaluated within 2 months unless there's significant pain.<ref group=notes>{{NU Hospital GroupInguinal hernia - indication and choice of modality}}</ref>
→Further workup if not detected: Emphasis
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[[File:Inguinal hernia.jpg|thumb|Indirect inguinal hernia (through the inguinal canal).]]
==Planning==
===How soon===In strong '''[[abdominal pain]]'''Swedish practice, a suspected strangulated hernia indicates surgery without previous ultrasound, whereas ultrasonography of an unclear diagnosis indicates '''[[abdominal CT]]'''inguinal bulge is performed within 2 months unless there is significant pain.<ref group=notes>{{NU Hospital Group}}</ref>
==Evaluation==
[[File:Ultrasonography of inguinal hernia (annotated).jpg|thumb|300px|Ultrasound of an indirect hernia containing fat, with testicle seen at right.]]
Without and with Valsalva maneuver.<ref name="JamadarJacobson2006">{{cite journal|last1=Jamadar|first1=David A.|last2=Jacobson|first2=Jon A.|last3=Morag|first3=Yoav|last4=Girish|first4=Gandikota|last5=Ebrahim|first5=Farhad|last6=Gest|first6=Thomas|last7=Franz|first7=Michael|title=Sonography of Inguinal Region Hernias|journal=American Journal of Roentgenology|volume=187|issue=1|year=2006|pages=185–190|issn=0361-803X|doi=10.2214/AJR.05.1813}}</ref> Preferably also in standing.<ref name="JamadarJacobson2006"/> Look primarily for an increased diameter of the inguinal canal, which is normally 2 cm (±1 cm in standard deviation) at the deep inguinal ring.<ref group="notes">±2.2cm ±1.08cm in Africans, and 2.1 cm 0.41 ±0.58cm in Europeans.</ref><ref name="MituraKozieł2018">{{cite journal|last1=Mitura|first1=Kryspin|last2=Kozieł|first2=Sławomir|last3=Pasierbek|first3=Michał|title=Ethnicity-related differences in inguinal canal dimensions between African and Caucasian populations and their potential impact on the mesh size for open and laparoscopic groin hernia repair in low-resource countries in Africa|journal=Videosurgery and Other Miniinvasive Techniques|volume=13|issue=1|year=2018|pages=74–81|issn=1895-4588|doi=10.5114/wiitm.2018.72579}}</ref>
===Further workupif detected===
If an inguinal hernia is detected:
*'''Size''' with and without provocation (Valsalva maneuver and/or standing)
*Ability to '''reduce''' by pressure
If the hernia is not clearly within the inguinal canal, check if it lies medially to the inferior epigastric vessels, since it is then classified as a ''direct hernia''.
===Further workup if NOT detected===
If the pain location may suggest it, also consider performing an '''[[Ultrasonography of femoral hernia]]''' and/or '''[[Ultrasonography of hydronephrosis]]''' in the same session.
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