The pubic tubercle: a CT landmark in groin hernia.

The aim of our study is to investigate the pubic tubercle as a reliable CT landmark in distinguishing the three types of groin hernia. CT scans of 42 patients with surgically confirmed groin hernia were reviewed. For each patient, both the anatomical structure within the hernia and the state of the hernia to the inferior epigastric artery were specifically recorded. Hernias were also located within a schematic construction of orthogonal lines focused on the pubic tubercle. In this construction, inguinal hernias were ventral to the X-axis while femoral hernias were dorsal to the X-axis. Among the inguinal hernias, direct inguinal hernias were located strictly lateral to the Y-axis while indirect inguinal hernias medially crossed the Y-axis. All these CT results were compared to the surgical findings. The inferior epigastric artery was visualized in 90% patients and, in these cases, the situation of the hernia to the artery on CT showed no discordance with surgical findings. Within the schematic construction of orthogonal lines focused on the pubic tubercle, 50% were considered as indirect inguinal hernias, 31% as direct inguinal hernias and 19% as femoral hernias. For each patient, the CT diagnosis was consistent with the surgical report.