Objective To explore the value of 16-slice spiral CT in differential diagnosis of oblique inguinal hernia and femoral hernia. Methods The clinical data of 112 patients with oblique inguinal hernia and femoral hernia confirmed by surgery were admitted to our hospital between January 2016 and January 2018 were analyzed retrospectively. All patients were given pelvic CT examination before operation, and the accuracy of 16-slice spiral CT was analyzed in the differential diagnosis of oblique inguinal hernia and femoral hernia, and the imaging features of location, line feed, morphology, contents, and the anatomical relationship with the surrounding structures of hernia were observed. Results The sensitivity, specificity and accuracy rate of 16-slice spiral CT were 92.13% (82/89), 90.63% (29/32) and 91.74% (111/121) in the differential diagnosis of oblique inguinal hernia and femoral hernia. Among 73 cases of patients with oblique inguinal hernia, there were 61 cases (83.56%) with enlarged inguinal canal and 46 cases (63.01%) with different degree enlargement of deep inguinal ring, 82 hernial sacs in the axial position and coronal position showed 52 (63.41%) in anterior side of spermatic cord or uterine round ligament and 30 (36.59%) in the anterior medial side, and the sagittal position showed that the hernia sacs were originated from the lateral side of the inferior epigastric artery, and the inguinal canal was located in front of inguinal ligament. The axial position of patients with femoral hernia showed the hernia sacs were originated in the inferior part of inferior epigastric artery and was located in the medial or anterior medial femoral vein, and the contents were located in the external quadrant of the tuberculum pubicum, and the coronal position showed that the hernia sacs were located within "the imaging femoral triangle", and the sagittal position showed that the hernia sacs were located in posterior inguinal ligament. Conclusion Oblique inguinal hernia and femoral hernia have characteristic images performance in 16-slice spiral CT examination, and CT has high accuracy in differential diagnosis of oblique inguinal hernia and femoral hernia.