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Abdominal Hernias

US and Inguinal Hernias.

Can they be used for clinically occult herniae?

NB: Dynamed says most hernias are diagnosable in men purely clinically and points out about 1/3 are asymptomatic.

Systematic Review and Meta-analysis 2018 1

  • n=16 studies, only 2 without verification bias.
  • of these 2 Sensitivity was 29% or 91%. Specificity=90%.
  • lots of issues with the studies. did not do pooled analyses apart from PPV = 86%.
  • Seems to be accurate for diff inguinal vs femoral.

CONCLUSION

More studies needed. Accuracy variable.

Anterior Wall Hernias

Umbilical Hernias 2

CONGENITAL

Normal in children upto 4-6 y old. Black>>White.
PATH: Relative deficiency in upper part of the umbilical ring which fails to fuse and scar adequately and herniation of peritoneal fat +/- bowel happens.
CF: Rare to stick. 80% will self-resolve. Rx: Surg only if large, symptomatic or persistent >5yr old.

ACQUIRED

Middle aged women >> men. But men more likely to incarcerate. Rx: Surg if big or symptomatic.

Ventral Hernia

DEFN: Midline & Lateral but not umbilical.

  • Epigastric = Above umbilicus in linea alba.
  • Hypogastric = Below umbilicus in linea alba. PATH:
  • Tend not to get better and progress.
  • Congenital diastasis & acquired factors including obesity, trauma. Rx: For any symptomatic one then surgery.
    Debate about asymptomatic.

Footnotes

  1. Kwee RM, Kwee TC. Ultrasonography in diagnosing clinically occult groin hernia: systematic review and meta-analysis. Eur Radiol. 2018;28(11):4550-4560. doi:10.1007/s00330-018-5489-9 ↩

  2. https://my.statdx.com/document/ventral-hernia/3ca94c86-62fd-41ef-bb1e-c44cfd5e0710?searchTerm=ventral%20hernia&searchType=documents&category=All ↩