Atypical Inguinal Hernia: Sonography for Fat Herniation Through the Canal Wall Defect

A groin mass can arise from multiple conditions, with common causes including hernias, enlarged lymph nodes, fluid collections, or tumors. An ultrasound, together with a clinical examination, plays a key role in diagnosing groin masses and identifying hidden hernias. A 44-year-old male presented with a painless right inguinal mass that had been continuously present for one month. Upon clinical examination, a positive silk-glove sign was noted, though both static and dynamic ultrasound imaging did not reveal the typical characteristics of hernias. Instead, a fat-containing mass, measuring 20.6 × 6.4 × 5.0 mm, was observed through a small defect in the inguinal canal wall near the superficial inguinal ring, without any vascular or tubular involvement. Due to minimal symptoms, the patient was advised to undergo conservative treatment, with a diagnosis of peritoneal fat herniation. This case emphasizes the value of high-resolution ultrasound in evaluating groin masses and suggests that in the absence of a typical hernia sac, conservative management and monitoring may help avoid unnecessary surgery.