Abdomen, Small bowel, Ultrasound, CT, Diagnostic procedure, Structured reporting, Hernia
N. M. F. Campos, A. I. Aguiar, C. T. Rodrigues, L. Curvo-Semedo, P. Donato; Coimbra/PT
Abdominal wall hernias are often diagnosed clinically,
but those that present with pain without a lump or bulge are often referred for diagnostic imaging .
Real-time ultrasound has several advantages over other imaging modalities:
Accessible and relatively fast exam
It does not use ionizing radiation
The ability to scan the patient in both upright and supine positions
Use of dynamic manoeuvers
Ability to document motion in real time
Positioning and dynamic maneuvers affect the ability to diagnose a hernia,
alter its size and contents,
evaluate its reducibility and enables us to assess tenderness and clinical significance of a hernia.
Hernias do not occur through the belly of abdominal wall muscles unless they have been surgically incised [1,2].
Hernias occur in anatomical points of natural weakness: areas where vessels penetrate the abdominal wall (femoral); inguinal canal (indirect inguinal hernia); aponeuroses and muscular sheath (direct inguinal hernia,
midline hernias) (Fig.
Classification of anterior abdominal wall hernias:
Inguinal hernias - They are the commonest type of abdominal wall herniation (up to 80 %) and are most often acquired.
There is a recognised male predilection [1,3,4].
direct inguinal - Less common,
acquired and are frequently bilateral.
indirect inguinal - More common
Femoral hernias - Account for about 5% of abdominal wall hernias.
More common in women .
Epigastric hernias - Account for about 1% of abdominal wall hernias .
Umbilical and paraumbilical hernias
Incisional hernias 
subxiphoidal; epigastric; umbilical; infraumbilical; suprapubic.
subcostal; flank; iliac; lumbar.