To conduct analysis of the CT manifestations of direct inguinal hernias with hernia sac entering the scrotum.

Retrospective analysis of clinical and CT imaging data of 13 patients with inguinal hernia sac entering the scrotum admitted to Yongkang First People's Hospital and Yongkang Hospital of Traditional Chinese Medicine from January 2018 to April 2024. Retrospective analysis of clinical and CT imaging data from 13 cases of direct inguinal hernias with hernia sac entering the scrotum. CT images were examined to record the position of the hernia sac, the display of inferior epigastric arteries and veins, and their relationship with the hernia sac neck, the lateral crescent sign presence, the hernia sac maximum cross-sectional diameter, and the depth of the hernia sac entering the scrotum.

All patients' hernia sacs were crossed over the pubic tubercle using the cross method, with the anterior outer edge of the pubic tubercle as the marker point for the Y-axis (vertical line). In all cases, the inferior epigastric arteries and veins were visible. the neck of the hernia sac was located on the inner side of the inferior epigastric arteries and veins. The lateral crescent sign was observed in 9 cases. The maximum cross-sectional diameter of the hernia sac ranged from 44.0 to 64.5 mm, with an average of (52.2±5.4) mm. In three case, the lower pole of the hernia sac reached the level of the testicle, while in ten cases, it was located above the level of the testicle.

Direct inguinal hernias with hernia sac entering the scrotum can be easily misdiagnosed as indirect inguinal hernias. The relationship between the inferior epigastric arteries and veins and the hernia sac neck, along with the presence of the lateral crescent sign, are key points for differentiation. Delabrousse E's "cross" crossmethod is not suitable for distinguishing inguinal hernias with hernia sac entering the scrotum.