CT-detected inguinal and femoral hernias in women: prevalence and interobserver agreement

BackgroundInguinal and femoral hernias in women show a reported diagnostic gap, with systematic evidence supported by cohorts composed of approximately 84% men.Materials and methodsWe conducted a descriptive, retrospective, cross-sectional observational study at a reference center in Bogotá during the 2024–2025 period. We included 494 women, 18 years or older, who had undergone abdominal computed tomography. Double reading by residents was applied, with 2-of-3 majority adjudication between the resident and two independent expert reviewers. Statistical analysis included 95% Wilson confidence intervals, Cohen's kappa with Landis–Koch interpretation, and sensitivity, specificity, positive predictive value, and negative predictive value, reported in accordance with STROBE guidelines.ResultsResident-diagnosed prevalence was 88 of 494 (17.8%; 95% CI 14.7–21.4). Adjudicated prevalence was 83 of 494 (16.8%; 95% CI 13.8–20.4). Five cases (1.0%) were reclassified as extraperitoneal fat by expert consensus. Findings included indirect inguinal predominance, bilateral distribution in 26.1%, a high proportion of occult hernias, and underreporting in the original radiology report. Resident sensitivity was 100% against both expert reviewers. Specificity was 84.4% against Reviewer 1 and 47.4% against Reviewer 2. Cohen’s kappa for resident vs. Reviewer 1 was 0.878; resident vs. Reviewer 2 was 0.326; and Reviewer 1 vs. Reviewer 2 was 0.408.ConclusionsThe radiological prevalence in women sits above the classical clinical range. Extraperitoneal fat is an overlooked differential diagnosis in female cohorts and accounts for a large part of interreviewer discordance. The 2-of-3 rule works as a replicable method for diagnostic studies with limited resources.