= Solution
\b[Abdominal <hernias> are classified primarily by the opening through which tissue protrudes; groin and scrotal swellings have a substantially wider differential diagnosis.] Reducibility, obstruction and strangulation describe the state of a <hernia>, rather than different anatomical sites.
The principal external varieties are <indirect inguinal hernia> and <direct inguinal hernia>, <femoral hernia>, <umbilical hernia> and other anterior abdominal-wall hernias, including <epigastric hernia> and <incisional hernia>. An <indirect inguinal hernia> enters through the deep inguinal ring lateral to the inferior epigastric vessels and can follow the canal into the <scrotum>; a <direct inguinal hernia> passes through the posterior wall medial to those vessels. A <femoral hernia> passes through the femoral canal below the <inguinal ligament>, rather than along the inguinal canal.<Surgical Mesh Used for Hernia Repair by the FDA>[Types of hernia: inguinal, femoral, incisional, ventral, umbilical and hiatal]{ref}
Less common wall or pelvic varieties include <lateral ventral hernia>, <lumbar hernia>, <obturator hernia>, <sciatic hernia> and <perineal hernia>. <Diaphragmatic hernia> defects allow abdominal contents into the thorax. <Internal hernias> can pass through a mesenteric or peritoneal aperture while remaining within the abdominal cavity, including paraduodenal recesses or the epiploic foramen. Contents may be <intestine>, <omentum> or other viscera; a developmental route and an acquired wall weakness can yield different forms at the same broad site.<Hernias of the Abdominal Wall by Merck Manual Professional Edition>[Anatomical varieties and distinction of inguinal and femoral defects]{ref}<Internal Hernias: A Difficult Diagnostic Challenge. Review of CT Signs and Clinical Findings>[Classification by aperture and internal location]{ref}
In the groin, alternatives to an inguinoscrotal <hernia> include enlarged or inflamed <lymph nodes>, an <abscess>, <lipoma> of the <spermatic cord> or other soft tissue, a retained or undescended <testis>, a <hydrocele> of the cord, a <saphena varix>, and a <femoral aneurysm> or pseudoaneurysm. A <femoral hernia> is also an important separate diagnosis. A fluid collection along a persistent female inguinal peritoneal process can produce a corresponding inguinal swelling. These lesions are not interchangeable merely because they lie near the inguinal opening.<Inguinal Hernias: Diagnosis and Management by the American Academy of Family Physicians>[Differential diagnosis of groin swelling]{ref}
In the <scrotum>, consider <hydrocele>, <haematocele>, <spermatocele> or an epididymal cyst, <varicocele>, <epididymitis>, <orchitis>, <abscess>, traumatic swelling and a <testicular tumour>. Torsion of the <testis> or its appendages can cause acute painful swelling. General <oedema> or <lymphoedema> can enlarge the scrotal wall diffusely rather than create one discrete lump.<Painless Scrotal Mass by Merck Manual Professional Edition>[Etiology: hydrocele, varicocele, cystic masses, haematocele, oedema and tumour]{ref}<The Acute Scrotum by the American Urological Association>[Differential diagnosis: torsion, trauma, infection and other acute swelling]{ref}
The discriminating examination locates the swelling relative to the <inguinal ligament> and to the <testis>, asks whether it is cystic or solid, and notes posture-related change, reducibility, cough impulse and transillumination when relevant. A cough impulse is not exclusive to a <hernia>; a communicating fluid collection or a venous swelling may vary with pressure. Modern <ultrasonography>, including assessment of <blood flow> when indicated, can clarify uncertain anatomy. \b[The site and character of a swelling must be established before it is called an inguinoscrotal hernia.]
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