Cruveilhier’s sign is the palpable swelling or bulge in the groin associated with an inguinal hernia.

• Detected by palpation of the inguinal canal during patient maneuvers such as coughing or straining.

• Indicates the presence of a herniated segment of tissue (typically intestine or omentum) that moves toward the examiner’s finger.

• Useful in diagnosing occult or difficult-to-detect inguinal hernias.

Pathophysiology

• Herniation of abdominal contents: A defect or weakness in the abdominal wall or inguinal canal allows tissue to protrude.

• Cough or Valsalva maneuver: Increases intra-abdominal pressure, forcing the herniated tissue to move into the canal.

• Palpable mass response: The examiner’s finger feels the herniated tissue push against it, confirming the hernia.

• Groin bulge: Swelling may be intermittent and may retract when intra-abdominal pressure decreases.

Examination technique

Patient Positioning

• Have the patient lie supine with one knee slightly flexed to relax the inguinal region.

Palpation Procedure

1. Insert your index finger into the inguinal canal on the side being examined.

2. Ask the patient to cough or perform a Valsalva maneuver.

3. Assess for a mass pushing against your finger during increased intra-abdominal pressure.

4. Observe whether the tissue withdraws when pressure normalizes, indicating reducibility.

Assessment Notes

• Compare both sides for asymmetry.

• Assess size, consistency, and reducibility of the herniated tissue.

Clinical utility

• Detection of inguinal hernia: Cruveilhier’s sign helps confirm hernias that may not be visible on inspection alone.

• Surgical planning: Helps localize the hernia and assess its reducibility.

• Monitoring progression: Useful in follow-up for patients with suspected hernias.

Differential Diagnosis

Pediatric considerations

• Common in boys due to incomplete closure of the processus vaginalis.

• May present as intermittent swelling noticed by parents during crying or straining.

Geriatric considerations

• Increased prevalence due to weakened abdominal wall musculature.

• Hernias may be larger, more prone to complications, and may present without typical pain.

Limitations

• Small or reducible hernias may be missed if patient is lying flat or tense.

• Uncooperative patients may not perform adequate cough or strain.

• Must be interpreted alongside clinical history and imaging when uncertain.

Patient counseling

• Explain that a palpable mass in the groin may represent a hernia.

• Advise the patient on surgical options, risk of incarceration, and monitoring.

• Educate about avoiding heavy lifting or straining until evaluation.

Conclusion

Cruveilhier’s sign is a reliable clinical indicator of inguinal hernia, particularly useful when the hernia is not obvious on inspection. Accurate palpation technique and patient cooperation are essential for proper detection, guiding further management and surgical intervention.

References

1. Cruveilhier J. Traité d’Anatomie Pathologique du Corps Humain. Paris: Baillière; 1829.

2. Fitzgibbons RJ, et al. Inguinal Hernia: Diagnosis and Management. N Engl J Med. 2006;354:1939–1948.

3. Kingsnorth A, LeBlanc K. Management of Abdominal Wall Hernias. Lancet. 2003;362:1561–1571.

4. Skandalakis PN, et al. Surgical Anatomy of the Inguinal Region and Hernias. Surg Clin North Am. 2000;80:1269–1296.

5. American College of Surgeons. Inguinal Hernia Guidelines. 2020.