Ultrasound of the Acute Scrotum

Phebe Chen, MD, Susan John, MD

Disclosures

Appl Radiol. 2006;35(3):8-17. 

In This Article

Inguinal Hernia

Inguinal hernias occur because of protrusion of peritoneal contents, usually omentum or bowel, through a patent processus vaginalis. Hernias are classified as direct or indirect by their relationship to the inferior epigastric artery (IEA). Direct hernias are located medial to the IEA, while indirect hernias are lateral to the IEA.[8]Fluid or air-filled loops of bowel with peristalsis in the scrotal sac are diagnostic of an inguinal hernia (Figure 9). Hyperechoic areas are likely to represent omentum. Incarceration of a hernia is most common before 6 months of age and in adulthood and is more common in indirect hernias. The presence of an akinetic dilated loop of bowel within the scrotum has a 90% sensitivity and specificity for strangulation. Be wary of contraction of the dartos muscle, which can cause movement that may mimic bowel peristalsis. The bowel wall can be thickened and hyperemic with incarcerated hernias. A Richter hernia consists of herniation of only the antimesenteric border of the bowel and may not result in intestinal obstruction. The diagnosis of Richter hernia is difficult to make sonographically.

This gray-scale ultrasound image of an inguinal hernia reveals a nondilated nonobstructed loop of bowel within the scrotum

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