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Groin swellings
These are common clinical problems, especially hernias. They are therefore common in clinical examinations.
Causes
Above the inguinal ligament
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Sebaceous cyst/abscess
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Lipoma
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Direct inguinal hernia
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Indirect inguinal hernia ( Fig. 26 )
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Imperfectly descended testis
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Hydrocele of the cord/canal of Nuck
Below the inguinal ligament
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Sebaceous cyst/abscess
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Lipoma
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Femoral hernia
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Lymph nodes
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Saphena varix
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Femoral artery aneurysm (true or false)
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Imperfectly descended testis
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Neuroma of the femoral nerves
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Synovioma of the hip joint
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Obturator hernia
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Psoas abscess
History
Diagnosis of most groin swellings will be based on the history and examination findings.
Sebaceous cyst/abscess
The patient will complain of a mobile lump on the skin. It may be red and inflamed and discharging. Ensure you ask about IVDU. These patients commonly present with an abscess.
Lipoma
The patient will present with a soft, painless swelling. A lipoma of the cord is often mistaken for a hernia.
Hernias
A patient with a groin hernia will present with a lump that disappears on recumbency or may be pushed back (reducible). The patient may present with a tense tender lump that cannot be reduced, accompanied by signs and symptoms of intestinal obstruction. Femoral hernia is more common in females. With hernias, there is occasionally a history of sudden straining (i.e. heavy lifting or chronic cough or trauma, following which a lump may become manifest).
Imperfectly descended testis
An imperfectly descended testis may present as a groin swelling. The patient, or, if in a young child, the mother, will have noticed absence of a testis from the scrotum. Enlargement and pain may indicate malignant change, which is more common in an imperfectly descended testis.
Hydrocele of the cord/canal of Nuck
In men a hydrocele may form around the cord or in women around the canal of Nuck. This may present as a lump in the inguinal region which does not reduce. It represents a cyst forming in the processus vaginalis.
Lymph nodes
Lymph nodes may present as swellings below the inguinal ligament. They may be discrete and firm, tender and red or matted to form a mass. The patient may have noticed a lesion on the leg. Care must be taken to elicit a full history with inguinal lymphadenopathy, as the nodes drain not only the tissues of the leg but also the penis, the scrotal skin, the lower half of the anal canal, the skin of the buttock and the skin of the lower abdominal wall, up to and including the umbilicus. In the female, they drain the labia, the lower third of the vagina and the fundus of the uterus, via lymphatics accompanying the round ligament down the inguinal canal. A careful history should therefore be taken, of any anorectal disease, e.g. bleeding PR, or gynaecological disease, e.g. bleeding PV to suggest a carcinoma of the uterus.
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