Distinguishing direct and indirect inguinal hernias.

Abstract

The paper by Giacchino and his colleagues,7 on which your recommendations for management are so clearly based, was criticised in the subsequent discussion for its conclusions that colonoscopy should not be performed and it is surprising that you should perpetuate this erroneous conclusion.There is clearly much evidence to support a co-ordinated approach to the problem of massive bleeding from the large bowel, involving the gastroenterologist, endoscopist, radiologist, and surgeon in a joint and flexible approach to investigation and management rather than adherence to the more rigid flow chart suggested.

Surface marking of the deep inguinal ring

“…Occlusion of the DIR is a test to diagnose an indirect inguinal hernia and to differentiate it from other hernias in the inguinal region as described by Clain (1994) and Browse (1997). Ralphs et al (1980) and Beattie (1980), however, question the accuracy of the test because of the incomplete description of the surface marking of the DIR.…”