A 40-year-old man has an intermittent groin swelling. When the examiner places firm pressure over the deep inguinal ring and asks the patient to cough, no bulge appears. On releasing the pressure, the swelling immediately appears at the superficial ring and travels obliquely toward the scrotum. This finding establishes the diagnosis of:

• A Direct inguinal hernia
• B Femoral hernia
• C Indirect inguinal hernia ✓
• D Inguinoscrotal lipoma

Explanation

This is the deep ring occlusion test. An indirect hernia traverses the deep ring, so controlling that ring prevents descent of the hernia, which reappears when pressure is released. A direct hernia pushes through the weakened posterior wall medial to the ring and therefore still bulges despite ring occlusion. A femoral hernia emerges below the inguinal ligament entirely, and a cord lipoma is a solid mass unrelated to the ring.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.