Type:
Educational Exhibit
Keywords:
Abdomen, Small bowel, Ultrasound, CT, Diagnostic procedure, Structured reporting, Hernia
Authors:
N. M. F. Campos, A. I. Aguiar, C. T. Rodrigues, L. Curvo-Semedo, P. Donato; Coimbra/PT
DOI:
10.26044/ecr2019/C-3464
Background
Abdominal wall hernias are often diagnosed clinically,
but those that present with pain without a lump or bulge are often referred for diagnostic imaging [1].
Real-time ultrasound has several advantages over other imaging modalities:
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Accessible and relatively fast exam
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It does not use ionizing radiation
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The ability to scan the patient in both upright and supine positions
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Use of dynamic manoeuvers
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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,
Spigelian hernias,
midline hernias) (Fig.
1).
Classification of anterior abdominal wall hernias:
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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].
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direct inguinal - Less common,
acquired and are frequently bilateral.
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indirect inguinal - More common
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Femoral hernias - Account for about 5% of abdominal wall hernias.
More common in women [5].
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Epigastric hernias - Account for about 1% of abdominal wall hernias [5].
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Umbilical and paraumbilical hernias
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Spigelian hernias
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Hipogastric hernias
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Incisional hernias [2]
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Midline zone:
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subxiphoidal; epigastric; umbilical; infraumbilical; suprapubic.
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Lateral:
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subcostal; flank; iliac; lumbar.