Differential diagnosis

The differential diagnosis of an inguinal hernia in a male is:

• hydrocoele of processus vaginalis
• hydrocoele of spermatic cord
• spermatocoele
• varicocoele
• undescended testis - inguinal hernia often occurs in association with this condition
• lipoma of spermatic cord or herniation of properitoneal fat into the cord through the inguinal ring

In females, consider:

• hydrocoele of canal of Nuck

For both sexes, consider also:

• femoral hernia - these may extend above the inguinal ligament after passing through the fossa ovalis femoris. But, if the examining finger is placed on the pubic tubercle, the neck of a sac of a femoral hernia lies lateral and below, whilst that of an inguinal lies above.
• lymphadenopathy or abscesses of the groin
• residual haematoma following trauma or spontaneous haemorrhage in patients taking anti-coagulants