図１〜図８で小腸だけの拡張を示しているので麻痺性イレウスではなく機械的小腸閉塞である．麻痺性イレウスでは多くの場合盲腸と上行結腸にも小腸と同様な液状内容物を認める．盲腸と上行結腸に通常便を認める（液状内容物を認めない），あるいは虚脱していたら機械的小腸閉塞の可能性が高い．Ce：盲腸，Ti：回腸末端，Dc：下行結腸，Sg：Ｓ状結腸．腸閉塞を疑ったらまず外ヘルニア嵌頓を検索することが基本である．図１９〜図２６の↑は腹腔外へ脱出した腸管で，図１９〜図２２でヘルニア嚢（sac）が恥骨結合部（白矢印）を超えて内側に広がり（下記文献），下降するに従って大腿動（△）静脈（▲）から離れていくので鼠径ヘルニアである．またヘルニアによる大腿静脈（▲）の圧排像を認めない．図１４の1から小腸が拡張し始め，数字順に口側へ展開する．手術で小腸が嵌頓した鼠径ヘルニアが確認され，嵌頓した小腸は出血性壊死に陥っており（図A：↑間）切除された．

文献考察１）鼠径部ヘルニアの解剖．大腿ヘルニアは鼠径靱帯の尾側（下方），鼠径ヘルニアは鼠径靱帯の頭側（上方），indirect inguinal hernia（外鼠径ヘルニア）は下腹壁動脈の外側から鼠径管を通って内側下方に，direct inguinal hernia（内鼠径ヘルニア）は下腹壁動脈の内側から鼠径管を通らずに直接脱出する（図１，２）．
AJR Am J Roentgenol. 2006 Jul;187(1):185-90.
Sonography of inguinal region hernias.
Jamadar DA, Jacobson JA, Morag Y, Girish G, Ebrahim F, Gest T, Franz M.

OBJECTIVE: The purpose of this article is to describe the anatomy of the inguinal region in a way that is useful for sonographic diagnosis of inguinal region hernias, and to illustrate the sonographic appearance of this anatomy. We show sonographic techniques for evaluating inguinal, femoral, and spigelian hernias and include surgically proven examples. CONCLUSION: Understanding healthy inguinal anatomy is essential for diagnosing inguinal region hernias. Sonography can diagnose and differentiate between various inguinal region hernias.PMID: 16794175（full text）

文献考察２）：大腿ヘルニアと鼠径ヘルニアのCTでの鑑別．鼠径ヘルニアはヘルニアサックが内側に拡大し恥骨結合を超え，大腿静脈の圧排所見がない．大腿ヘルニアはヘルニアサックが恥骨結合の外側に限局し，大腿静脈の圧排所見を認める（表）.

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AJR Am J Roentgenol. 2007 Aug;189(2):W78-83（web版）.
Differentiation of femoral versus inguinal hernia: CT findings.
Suzuki S, Furui S, Okinaga K, Sakamoto T, Murata J, Furukawa A, Ohnaka Y.

OBJECTIVE: The purpose of our study was to investigate the CT findings of femoral hernias, focusing on their differentiation from inguinal hernias. MATERIALS AND METHODS: We reviewed the records of 46 femoral hernias in seven centers (review of femoral hernias) and those of 215 groin hernias (femoral hernias, 11; inguinal hernias, 204) in one center (review of groin hernias). We evaluated the presence of hernia, extent of hernia sac based on the relationship between the hernia sac and the pubic tubercle (localized sac: sac was localized lateral to the pubic tubercle; or extended sac: sac extended medial to the pubic tubercle), and compression of the femoral vein on CT images. The chi-square test was used to assess the relationship between the CT findings and femoral versus inguinal hernias in the review of groin hernias. RESULTS: In the review of 46 femoral hernias, the lesions were detected on CT in 45. In the 45 lesions, all hernia sacs were localized, and 42 lesions showed venous compression. In the review of 215 groin hernias, all 11 femoral hernias had localized sacs with venous compression on CT. Of the 204 inguinal hernias, 98 lesions were detected on CT, 65 had extended sacs, and only 10 showed venous compression. Localized sacs with venous compression were seen much more often in the femoral hernias (11/11, 100%) than in the inguinal hernias (1/92, 1.1%) (p