Abdominal wall hernias: review of herniography and correlation with cross-sectional imaging

Diagnosis and treatment of a rare case of an incarcerated bilateral Spigelian hernia with the vermiform appendix and caecum

Spigelian hernia is a rare form of abdominal wall defect. Bilateral Spigelian hernias are even less common. Surgical repair of Spigelian hernias is recommended due to their high risk of incarceration and strangulation of abdominal contents. A variety of surgical approaches to repair these hernias have been described in the literature including the traditional open approach, laparoscopic transabdominal preperitoneal approach, laparoscopic intraperitoneal repair and laparoscopic totally extraperitoneal repair. Here, we present the case of an elderly female patient with rare bilateral Spigelian hernias, the right side containing incarcerated appendix and caecal pole. The left hernia was unrecognised on preoperative CT imaging. To our knowledge, very few cases have been reported in the literature. The patient underwent bilateral laparoscopic intraperitoneal mesh repair. All technical aspects of the treatment are discussed here, in the context of the current literature, including the surgical technique and the limitations of the CT diagnosis. We aim to summarise the background of these uncommon hernias, the limitations of preoperative investigations and the differences between the available operative approaches.

Spigelian Hernia Including the Urinary Bladder: A Rare Potential Cause of Surgical Complication

Spigelian hernia is a rare type of anterior abdominal wall hernia. While it is itself very rare, seeing urinary bladder in this hernia is even rarer. Here, in this case, we specifically illustrate a rare case of Spigelian hernia including the urinary bladder, diagnosed with computerized tomography.

Case of Spigelian hernia with incarcerated appendix

Spigelian hernias are uncommon lateral ventral wall hernias with a significant rate of incarceration; these hernias often produce nonspecific clinical signs and symptoms as well as elusive imaging findings. Although there are reported cases of incarcerated appendices within Spigelian hernias, this case specifically illustrates the diagnostic difficulty these hernias present to both surgeons and radiologists. Additionally, we discuss important anatomy, demographics and risk factors, clinical symptoms, imaging pitfalls and recommendations for repair based on a review of literature.

An Evaluation of the Diagnostic Potential of CT Scans and Herniography for Inguinal Hernias

We evaluated and compared the diagnostic potential of computed tomography (CT) and herniography in the identification of inguinal hernias. Herniography is typically utilized in the diagnosis of inguinal hernias in our institute. We utilized transabdominal preperitoneal repair in the treatment of inguinal hernias since October 2010 and performed a laparoscopic diagnosis followed by single-incision laparoscopic surgery for totally extraperitoneal repair since November 2013. We herein evaluated and compared the diagnostic potential of CT and herniography. From February 2012 to March 2016, 46 patients (male/female: 43/3; median age: 70 years) with 63 inguinal hernias were investigated using CT and herniography. We classified each inguinal hernia according to the Japan Hernia Society classification using CT (prone position) and herniography, and evaluated the accuracy of each of the diagnostic methods. A total of 29 patients had unilateral hernias and 17 had bilateral hernias; 62% (39/63) and 84% (53/63) of the inguinal hernias were correctly diagnosed and classified by CT and herniography, respectively. A total of 87% (55/63) and 98% (62/63) of the inguinal hernias were detected by CT and herniography, respectively. Thus, herniography was found to be more sensitive than CT and the difference in the detectability of inguinal hernias by the 2 methods was statistically significant. Herniography appears to be superior to CT, for both the classification and detection of inguinal hernias.

Combined epigastric hernia repair and mini-abdominoplasty. Case report

The objectives of abdominal hernia repair are to restore the structural integrity of the abdominal wall. Current techniques include primary closure, staged repair and the use of prosthetic materials. Techniques for mini-abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. We report a case of epigastric hernia repair through a transverse lower abdominal incision with the resection of excess of skin. Our purpose is to evaluate the results of the procedure by incorporating these aspects into an epigastric hernia repair, we found out that the procedures are made safer and the results are improved. Proper indication and details of the technique are described.

Pre-, intra-, and postoperative sonography of the abdominal wall in patients with incisional hernias repaired via a three-layered operative suture method

We illustrate the various sonographic (US) appearances of the abdominal wall following this type of repair, including partial and complete recurrences. Correlation is made with CT imaging. The three-layered anatomical reconstruction of an incisional hernia is described.

Perineal hernia

Abdominal wall hernias are a common abdominal pathology with higher prevalence in our population. It is usually asymptomatic but complications such as strangulation, incarceration or bowel obstruction need early detection and emergency surgery. The purpose of this article is to describe the infrequent type of hernia, illustrate the imaging findings and review the differential diagnosis. A 76-year-old woman was admitted in the emergency room with abdominal pain, vomits and diarrhoea. At her admission, a colonoscopy was attempted to perform but it was not possible to go beyond the stenosis. A barium enema and a multi-detector computed tomography (MDCT) were performed revealing a large mass in the left ischiorectal fossa, containing herniated loops of sigmoid colon adjacent to rectum. Abdominal wall hernias occur at areas of congenital or acquired weakness in the abdominal wall and are considered external hernias. MDCT is essential to identify wall hernias, make an accurate diagnosis and help for its clinical assessment. Knowing the radiological features of various types of abdominal hernias on MDCT and barium-enhanced radiographs allows confident diagnosis of these pathologies.

Sports hernias

Sportsman's hernia is an increasingly recognized cause of chronic groin pain in athletes. Although the definition is controversial, it is a condition of chronic inguinal/pubic exertional pain caused by rectus abdominal wall weakness or injury without a palpable hernia, usually affecting high-performance male athletes. Diagnosis is made after careful history and physical examination. Some radiographic studies such as ultrasound or MRI may be helpful in evaluating these patients and ruling out other pathology, although no radiographic study can rule out sportsman's hernias. Because sports hernias are not true hernias but an injury in the rectus insertion, unilateral or bilateral rectus reattachment is the most appropriate surgical treatment. This reattachment may be done in combination with adductor release in the setting of adductor pain or weakness on physical examination. Other surgical repairs (eg, Lichtenstein, Shouldice, Kugel, laparoscopic) do not stabilize the pelvis and tend not to be as successful. In the motivated patient, after surgical repair and physical rehabilitation, 95% are free of pain and able to return to competitive sports.

The pubic tubercle: a CT landmark in groin hernia

The aim of our study is to investigate the pubic tubercle as a reliable CT landmark in distinguishing the three types of groin hernia. CT scans of 42 patients with surgically confirmed groin hernia were reviewed. For each patient, both the anatomical structure within the hernia and the state of the hernia to the inferior epigastric artery were specifically recorded. Hernias were also located within a schematic construction of orthogonal lines focused on the pubic tubercle. In this construction, inguinal hernias were ventral to the X-axis while femoral hernias were dorsal to the X-axis. Among the inguinal hernias, direct inguinal hernias were located strictly lateral to the Y-axis while indirect inguinal hernias medially crossed the Y-axis. All these CT results were compared to the surgical findings. The inferior epigastric artery was visualized in 90% patients and, in these cases, the situation of the hernia to the artery on CT showed no discordance with surgical findings. Within the schematic construction of orthogonal lines focused on the pubic tubercle, 50% were considered as indirect inguinal hernias, 31% as direct inguinal hernias and 19% as femoral hernias. For each patient, the CT diagnosis was consistent with the surgical report.

Abdominal Hernias: Imaging Review and Historical Perspectives

Many eminent anatomists originally described abdominal hernias, some of which are still named after the original authors. In this article, the radiologic features of abdominal hernias are reviewed as imaged on x-ray, ultrasound, multidetector computed tomography, and magnetic resonance imaging. Recognition of the typical appearance of various types of abdominal hernias and associated adverse features such as bowel obstruction, perforation, strangulation, or volvulus formation can help in formulating an accurate diagnosis. A short biography of the scientists associated with eponymous hernias and their other important scientific contributions are also described.

Inguinofemoral Hernia: Accuracy of Sonography in Patients with Indeterminate Clinical Features

OBJECTIVE

The objective of our study was to investigate the accuracy of sonography in patients with symptoms suggestive of a hernia and normal or equivocal clinical examination findings.

SUBJECTS AND METHODS

Fifty-nine consecutive patients (47 men, 12 women; median age, 51 years; range, 19-82 years) were enrolled in a prospective study of sonography and herniography for investigation of inguinofemoral pain. All patients were referred with a history suggestive of hernia but with equivocal clinical features by three experienced surgeons. All patients underwent sonography and herniography examinations performed by experienced radiologists blinded to clinical details. The imaging variables recorded for each side were normal (including posterior inguinal wall bulging), hernia (indirect, direct, femoral, and abdominal wall), or nondiagnostic. The percentage of exact agreement, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for sonography and herniography and were compared with surgery when performed; then all sides for sonography were compared with herniography.

RESULTS

Surgery was performed in 18 patients (31%) on 21 sides and found hernia (n = 20) and patulous posterior inguinal wall (with no hernia) (n = 1). Compared with surgery, the results of sonography versus herniography, respectively, were exact agreement (91% vs 71%), sensitivity (95% vs 70%), specificity (100% vs 100%), PPV (100% vs 100%), and NPV (50% vs 14%). The sensitivity of sonography was significantly higher than that of herniography (McNemar test, p = 0.025). Both techniques had one false-negative in the same patient. Herniography had five additional false-negatives identified as hernias at sonography and surgery. Compared with herniography as the reference, the sonography findings were in exact agreement in 91% (107/118) of the cases; and sensitivity was 90% (19/21); specificity, 91% (88/97); PPV, 68% (19/28); and NPV, 98% (88/90).

CONCLUSION

Sonography is an accurate technique for the detection of inguinofemoral hernias in patients with clinically equivocal findings.

Anterior abdominal wall hernias: findings in barium studies

Findings of anterior abdominal wall hernias at computed tomography and magnetic resonance imaging are well documented; however, little information is available about the depiction and characterization of such hernias in barium studies, primarily in small-bowel follow-through examinations. Such examinations are performed frequently, and radiologists should be familiar with the hernia features that may be observed. Anterior abdominal wall hernias are best recognized in profile on lateral spot images from a small-bowel follow-through study when one or more loops of bowel extend beyond the fascial planes of the anterior abdominal wall, with luminal narrowing at the entry or exit site of the hernia or at both sites. In some patients, the hernia also can be recognized indirectly on a frontal view because of the displacement and, often, extrinsic compression or deformity of herniated bowel loops. In such cases, additional views should be obtained with the patient in the lateral position to confirm the presence of the hernia with direct visualization of the herniated loops in profile. The reducibility of bowel from an anterior abdominal wall hernia also can be assessed with manual palpation of the abdominal wall while the patient is in the lateral position. Manual palpation performed during fluoroscopy helps determine whether the bowel loops can be returned to the proper location or are fixed in the hernia, an important observation because of the higher risk of obstruction or strangulation when the bowel is incarcerated. Fluoroscopy therefore is a useful technique for the detection and characterization of anterior abdominal wall hernias in barium studies.

Abdominal Wall Hernias: Imaging Features, Complications, and Diagnostic Pitfalls at Multi–Detector Row CT

Abdominal wall hernias are a common imaging finding in the abdomen and may be complicated by strangulation, incarceration, or trauma. Because of the risk of developing complications, most abdominal wall hernias are surgically repaired, even if asymptomatic. However, post-surgical complications are also common and include hernia recurrence, infected and noninfected fluid collections, and complications related to prosthetic material. Multi-detector row computed tomography (CT) with its multiplanar capabilities is particularly useful for the evaluation of unrepaired and surgically repaired abdominal wall hernias. Multi-detector row CT provides exquisite anatomic detail of the abdominal wall, thereby allowing accurate identification of wall hernias and their contents, differentiation of hernias from other abdominal masses (tumors, hematomas, abscesses), and detection of pre- or postoperative complications. These findings improve the communication of imaging results to clinicians and help optimize treatment planning. Knowledge of multi-detector row CT findings in unrepaired and surgically repaired abdominal wall hernias and their complications is essential for making the correct diagnosis and may help guide clinical management.

Valeur de l’épine du pubis comme repère TDM des hernies de l’aine

PURPOSE

To assess the value of the pubic tubercle as a CT reference point in diagnosing the different types of groin hernia before surgery in patients presenting with mechanical bowel obstruction.

MATERIALS AND METHODS

Retrospective review of CT examinations performed for small bowel obstruction in our department during 2003. Twelve cases of groin hernia causing small bowel obstruction were included. All CT examinations were reviewed by 2 abdominal radiologists. The surgical report of all 12 included cases was reviewed for final diagnosis.

RESULTS

Twelve cases of groin hernia causing small bowel obstruction were reviewed in our department during 2003. Eight cases corresponded to small bowel obstruction caused by inguinal hernia (4 direct and 4 indirect) and 4 to small bowel obstruction caused by femoral hernia. In each case, the diagnosis suggested at CT using the pubic tubercle as a reference point was surgically confirmed.

CONCLUSION

The pubic tubercle is an excellent reference point at CT for diagnosing inguinal and femoral hernias. Preoperative diagnosis is important because it may change the choice of surgical procedure.

MDCT of Abdominal Wall Hernias: Is There a Role for Valsalva's Maneuver?

OBJECTIVE

Our objective was to evaluate the role of Valsalva's maneuver during MDCT for the diagnosis and characterization of abdominal wall hernias.

SUBJECTS AND METHODS

From September 2002 to May 2003, 100 consecutive patients (37 men and 63 women; mean age, 53 years) with suspected anterior abdominal wall hernias underwent 4-, 8-, or 16-MDCT with and without Valsalva's maneuver. Patients received both oral and IV contrast material. On a workstation, three independent reviewers evaluated each scan obtained during rest and during Valsalva's maneuver for the following parameters: anteroposterior (AP) diameter of the abdomen; presence, location, and contents of the hernia; and transverse diameter of the fascial defect. The scans were compared to assess for changes in hernia size and contents and to determine whether the hernia would have been overlooked without Valsalva's maneuver. Fisher's exact test, the McNemar test, and Cohen's kappa coefficient were used to assess for significant differences.

RESULTS

The three reviewers identified a mean of 72 abdominal wall hernias (72%). The reviewers agreed (kappa = 0.723) with respect to the presence of a hernia. AP diameters increased an average of 1.33 cm during Valsalva's maneuver (p < 0.001). The transverse diameter of the fascial defect increased an average of 0.66 cm and the AP diameter of the hernia sac increased an average of 0.79 cm during Valsalva's maneuver (p < 0.001). Fifty percent of the hernias became more apparent with Valsalva's maneuver. Ten percent of the hernias could be detected only on the scan obtained during Valsalva's maneuver. Conversely, in no patients was the hernia detected only on the rest scan.

CONCLUSION

As opposed to scans obtained at rest, scans obtained during Valsalva's maneuver aid in the detection and characterization of suspected abdominal wall hernias. A single scan obtained during Valsalva's maneuver is sufficient to detect 100% of anterior abdominal wall hernias identified on CT.

CT herniography in the diagnosis of occult groin hernias

AIM

To evaluate the role of computed tomography (CT) after herniography in the diagnosis and management of primary and recurrent groin hernias not detectable on clinical examination.

MATERIAL AND METHODS

Fifty-one patients underwent CT post-herniography over a 6-year period for suspected primary or recurrent inguinal hernia. The herniography and post-herniography CT findings were retrospectively compared with clinical and surgical follow-up. Statistical analysis was performed to assess the role of herniography and CT post-herniography in the primary and recurrent groups.

RESULTS

Of the 51 patients investigated for occult inguinal hernia, 19 had previous hernia repair with possible recurrence. The most common symptom at presentation was groin pain or discomfort (84%). Seventy-five percent in the primary group and 84% in the recurrent group had no findings on herniography or CT. Nine percent in the primary group and 16% in the recurrent group had hernias diagnosed by herniography. CT did not enhance the detection of hernia. Sensitivity for herniography and CT herniography in the primary groin hernia group was 75% as against specificity, which was 100 and 90%, respectively. For the recurrent groin hernias, sensitivity was 60% for herniography and 40% for CT herniography and specificity 100% for both.

CONCLUSION

CT performed post-herniography did not provide any benefit over performing herniography alone in the diagnosis of occult primary or recurrent inguinal hernias.

Inguinal hernias: MRI and ultrasound

This article presents an overview of the key anatomic structures of the groin region as seen on gross anatomy and the appearance of these structures on ultrasound and magnetic resonance imaging (MRI). An overview of the sonographic and MRI techniques used in preoperative diagnosis of inguinal hernias is provided, and their value is discussed. Finally, the role of ultrasound and MRI after surgical inguinal hernia repair is addressed.

Abdominal wall hernias: cross-sectional imaging signs of incarceration determined with sonography

OBJECTIVE

The aim of this study was to determine with sonography whether distinct cross-sectional imaging signs exist that may differentiate between incarcerated and nonincarcerated abdominal wall hernias.

SUBJECTS AND METHODS

The sonographic appearance of 149 consecutive abdominal wall hernias was prospectively investigated and correlated with subsequent surgical results. Commercially available 4- to 10-MHz linear transducers and 2- to 5-MHz curved transducers were used to evaluate the hernias.

RESULTS

Surgery revealed 126 nonincarcerated and 23 incarcerated hernias. The sonographic signs suggestive of incarceration that we identified included free fluid in the hernia sac, which was observed in 91% of the incarcerated hernias and in 3% of the nonincarcerated hernias; bowel wall thickening in the hernia, which was detected in 88% of the incarcerated hernias and in none of the nonincarcerated hernias; fluid in the herniated bowel loop, which was detected in 82% of the incarcerated hernias and in 3% of the nonincarcerated hernias; and dilated bowel loops in the abdomen, which occurred in 65% of the incarcerated hernias and in none of the nonincarcerated hernias. These imaging findings allowed the identification of incarceration in all 23 cases and led to a false-positive result in two of 126 nonincarcerated hernias.

CONCLUSION

Cross-sectional imaging signs indicating hernial incarceration included free fluid in the hernial sac, bowel wall thickening in the hernia, fluid in the herniated bowel loop, and dilated bowel loops in the abdomen. Sonography is an appropriate cross-sectional imaging modality for detecting these signs that are helpful in diagnosing patients with atypical clinical presentations.

Abdominal wall hernias: imaging with spiral CT

Computed tomography is an accurate method of identifying the various types of abdominal wall hernias, especially if they are clinically occult, and of distinguishing them from other diseases such as hematomas, abscesses and neoplasia. In this study we examined the CT images of 94 patients affected by abdominal wall hernias observed over a period of 6 years. Computed tomography clearly demonstrates the anatomical site of the hernial sac, the content and any occlusive bowel complications due to incarceration or strangulation. Clinical diagnosis of external hernias is particularly difficult in obese patients or in those with laparotic scars. In these cases abdominal imaging is essential for a correct preoperative diagnosis and to determine the most effective treatment.

Tailored helical CT evaluation of acute abdomen

Helical computed tomography (CT) allows rapid, cost-effective evaluation of patients with acute abdominal pain. Tailoring the examination to the working clinical diagnosis by optimizing constituent factors (eg, timing of acquisition, contrast material used, means and rate of contrast material administration, collimation, pitch) can markedly improve diagnostic accuracy. Rapid (>/=3 mL/sec) intravenous injection of contrast material is required for optimal assessment of acute pancreatitis, ischemic bowel, aortic aneurysm, and aortic dissection. Narrow collimation and small reconstruction intervals can help detect calculi in the biliary system and genitourinary tract. Tailored helical CT in patients with acute pyelonephritis usually involves several acquisitions through the kidneys during various phases of renal enhancement. In patients with suspected renal infarction, CT protocol must include an acquisition during the corticomedullary phase. Helical CT with 5-mm collimation through the lower abdomen and pelvis is used to evaluate patients with suspected diverticulitis. Use of both oral and intravenous contrast material can help localize small bowel perforation and characterize related complications. Tailored helical CT for assessment of abdominal hemorrhage consists of initial unenhanced CT followed by optional contrast material-enhanced CT. Clear communication between the radiologist, the patient, and the referring physician is essential for narrowing the differential diagnosis into a working diagnosis prior to helical CT.

Sportsman's hernia

BACKGROUND

Sportsman's hernia is a debilitating condition which presents as chronic groin pain. A tear occurs at the external oblique which may result in an occult hernia. The definition, investigation and treatment of this condition remain unclear.

METHODS

A systematic Medline search was performed and all literature pertaining to chronic groin pain, groin injury, sportsman's hernia and sportsman's groin from 1962 to 1999 was retrieved for analysis.

RESULTS

The costs of computed tomography and magnetic resonance imaging are such that their routine use for assessment of patients with groin pain cannot be justified. They may, however, be employed in difficult cases to help define the anatomical extent of a groin injury. Plain radiography, ultrasonography and scintigraphy should be the usual first-line investigations to supplement clinical assessment. Herniography may help in situations of obscure chronic groin and pelvic pain. There is no consensus view supporting any particular surgical procedure for sportsman's hernia. A number of reports have been published describing different repairs of the posterior inguinal wall deficiency. Appropriate repair of the posterior wall results in therapeutic benefit in selected cases.

CONCLUSION

The diagnosis of sportsman's hernia is difficult. The condition must be distinguished from the more common osteitis pubis and musculotendinous injuries. Early surgical intervention is usually, although not always, successful when conservative management has failed.

Targeted helical CT of the acute abdomen: appendicitis, diverticulitis, and small bowel obstruction

CT, especially helical CT, provides a fast and reliable modality for evaluation of the patient presenting with acute abdominal pain. Helical CT can provide an accurate diagnosis in the majority of patients and has found great utility in the evaluation of acute gastrointestinal emergencies, including acute appendicitis, diverticulitis, and small bowel obstruction. This article reviews proper helical CT technique, diagnostic imaging findings, and pitfalls of interpretation in evaluation of these acute abdominal disorders.

Abdominal wall hernias: imaging with spiral CT

Computed tomography is an accurate method of identifying the various types of abdominal wall hernias, especially if they are clinically occult, and of distinguishing them from other diseases such as hematomas, abscesses and neoplasia. In this study we examined the CT images of 94 patients affected by abdominal wall hernias observed over a period of 6 years. Computed tomography clearly demonstrates the anatomical site of the hernial sac, the content and any occlusive bowel complications due to incarceration or strangulation. Clinical diagnosis of external hernias is particularly difficult in obese patients or in those with laparotic scars. In these cases abdominal imaging is essential for a correct preoperative diagnosis and to determine the most effective treatment.

Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings

OBJECTIVE

To determine the diagnostic accuracy of physical examination, ultrasound, and dynamic MRI in patients with inguinal hernia.

METHODS

In 41 patients with clinically evident herniations, 82 groins were evaluated using a standard ultrasound and MRI protocol, the latter including T1- and T2-weighted sequences as well as two dynamic sequences. All ultrasound examinations and MRI scans were reviewed without knowledge of clinical findings. In all cases, correlation with findings at laparoscopic surgery was made.

RESULTS

At surgery, 55 inguinal herniations were found. Physical examination revealed 42 herniations (one false-positive finding), whereas ultrasound made the diagnosis of a hernia in 56 cases (five false-positive and four false-negative findings). MRI diagnosed 53 herniations (one false-positive and three false-negative findings). Thus, sensitivity and specificity figures were 74.5% and 96.3% for physical examination, 92.7% and 81.5% for ultrasound, and 94.5% and 96.3% for MRI.

CONCLUSIONS

In patients with clinically uncertain herniations, MRI is a valid diagnostic tool with a high positive predictive value.

Ultrasound of Abdominal Wall Hernias

Abdominal hernias are a common clinical entity and can be a diagnostic challenge. Sonographic evaluation can provide not only realtime diagnosis of a potential hernia, but this modality also offers the added advantage of dynamic maneuvers. Consequently, hernia contents as well as reducibility, can be determined. Ultrasound should be the primary modality for evaluation of suspected abdominal wall hernias.

Illustrated review of new imaging techniques in the diagnosis of abdominal wall hernias

BACKGROUND

The assessment of abdominal wall hernias has long been a clinical skill that only occasionally required the supplementary radiological assistance of herniography. However, with the advent of cross-sectional imaging, a new range of diagnostic tools is now available to help the clinician in difficult cases.

METHODS

This review explores the ability of computed tomography and magnetic resonance imaging to demonstrate many of the hernias encountered in the anterior abdominal wall. Also discussed is the role of imaging techniques in the management of a variety of hernias.

RESULTS AND CONCLUSION

Cross-sectional imaging techniques are being employed with increasing frequency for the assessment of hernias. Although the anatomical detail can usually be delineated clearly, the accuracy of the various methods and their place in the clinical management of hernias has yet to be fully determined.

Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian Rules footballers

OBJECTIVES

To investigate the prevalence of inguinal canal posterior wall deficiency (sports hernia) in professional Australian Rules footballers using an ultrasound technique and correlate the results with the clinical symptom of groin pain.

METHODS

Thirty five professional Australian footballers with and without groin pain were investigated blind with a dynamic high resolution ultrasound technique for presence of posterior wall deficiency.

RESULTS

Fourteen players had a history of significant recent groin pain and ten of these were found to have bilateral inguinal canal posterior wall deficiency (p < 0.01). The relative risk for a history of groin pain with bilateral deficiency was 8.0 (95% confidence interval 1.73 to 37.1). Groin pain was also found to be associated with increasing age (p < 0.01) which was an independent risk factor. Surgical, clinical, and ultrasound follow up for players who underwent hernia repair confirmed the validity of ultrasound as a diagnostic tool.

CONCLUSIONS

Dynamic ultrasound examination is able to detect inguinal canal posterior wall deficiency in young males with no clinical signs of hernia. This condition is very prevalent in professional Australian Rules footballers, including some who are asymptomatic. There was a correlation between bilateral deficiency and groin pain, although the temporal relationship between the clinical and ultrasound findings is not established by the current study. Ultrasound shows promise as a diagnostic tool in athletes with chronic groin pain who are considered possible candidates for hernia repair.

Dynamic magnetic resonance imaging in the diagnosis of groin hernia

RATIONALE AND OBJECTIVES

The authors determine the feasibility of dynamic magnetic resonance (MR) imaging in the diagnosis of groin hernia.

METHODS

Ten volunteers and 10 patients with clinically evident and surgically proven herniations were evaluated using T1-, and T2-weighted sequences and two dynamic sequences. The visibility of anatomic structures that are crucial for the assessment and the differentiation of inguinofemoral herniations was evaluated.

RESULTS

The inguinal rings could be identified in all subjects. The inferior epigastric vessels could be identified in 85%. In 10 patients, 11 hernias were found at MR imaging, whereas at surgery and physical examination 13 herniations were diagnosed (84.6%). The two hernias that were missed initially could be identified retrospectively on MR imaging. One volunteer showed a small bilateral inguinal hernia on MR imaging that could be confirmed on physical examination.

CONCLUSIONS

The anatomic structures that are crucial for the assessment and the differentiation of inguinofemoral herniations can be identified prospectively with MR imaging.

Abdominal wall hernias

Abdominal wall hernias are usually asymptomatic, discovered incidentally on physical examination. Emergency physicians, however, may be called on to deal with the potential life-threatening complications of abdominal wall hernias. This article discusses the anatomy, pathophysiology, and specific types of hernias in the adult and pediatric patient populations. Also covered are the complications of hernias, emergency interventions for hernia reduction, and urgent surgical consultation.