Francis is a middle-aged man who noted right-sided lower abdominal pain after straining with yard work. Which of the following would make a hernia more likely?
A) Absence of pain with straining
B) Absence of bowel sounds in the scrotum
C) Absence of a varicocele
D) Absence of symmetry of the inguinal areas with straining
D) Absence of symmetry of the inguinal areas with straining
Even in the presence of a hernia, absolute symmetry to inspection may be preserved. The action of straining and increasing intra-abdominal pressure causes the hernia to protrude. Hernias will not necessarily be present on CT scans either unless this maneuver is undertaken. Pain with straining and bowel sounds heard in the scrotum further support the diagnosis of indirect hernia.
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