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ECR 2019 / C-3464
Certificate of Merit
Dynamic ultrasound of abdominal wall hernias
Congress: ECR 2019
Poster No.: C-3464
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:

  1. Accessible and relatively fast exam

  2. It does not use ionizing radiation

  3. The ability to scan the patient in both upright and supine positions  

  4. Use of dynamic manoeuvers

  5. 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:

 

  1. 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].

    1. direct inguinal - Less common, acquired and are frequently bilateral.

    2. indirect inguinal - More common

  2. Femoral hernias  - Account for about 5% of abdominal wall hernias. More common in women [5].

  3. Epigastric hernias  - Account for about 1% of abdominal wall hernias [5].

  4. Umbilical and paraumbilical hernias

  5. Spigelian hernias

  6. Hipogastric hernias

  7. Incisional hernias [2]

    1. Midline zone:

      1. subxiphoidal; epigastric; umbilical; infraumbilical; suprapubic.

    2. Lateral:

      1. subcostal; flank; iliac; lumbar.

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