Sonography of Inguinal Region Hernias

Jamadar, David A.; Jacobson, Jon A.; Morag, Yoav; Girish, Gandikota; Ebrahim, Farhad S.; Gest, Thomas R.; Franz, Michael

doi:10.2214/ajr.05.1813

Cited by 112 publications

(84 citation statements)

References 6 publications

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“…When a Spi- figure 1 Computed tomography of the appendix root at the caecal pole traversing the right Spigelian hernia orifice (asterisk) and entering the hernia sac (arrow) figure 2 Computed tomography of the appendix in cross section in the hernia sac (arrow) gelian hernia is suspected clinically, sonography has been shown to be an effective and accurate imaging modality. 5 In the emergency setting, where the diagnosis may be in doubt and other intra-abdominal pathology is suspected, CT may be more reliable and it diagnosed the hernia accurately in the case described here.…”

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confidence: 70%

Appendicitis in a Spigelian hernia: an unusual cause for a tender right iliac fossa mass

Thomas

Avula

England

et al. 2013

annals

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Spigelian hernias are a rare type of hernia through the Spigelian aponeurosis, whose contents commonly include omentum or small bowel. In the absence of incarceration or strangulation, they can be difficult to diagnose clinically. In the emergency setting, they can present rarely as a painful abdominal mass and computed tomography provides a reliable diagnostic imaging modality. We report an emergency presentation of a Spigelian hernia containing the appendix. KeywORdsSpigelian hernia -Appendix -Computed tomography -Sonography -Appendicectomy Case historyA 74-year-old man presented acutely to the accident and emergency department of a district general hospital with a 5-day history of absolute constipation. This was associated with a large, painful swelling in the right lower quadrant of the abdomen. He had complained of a much smaller 'lump' in this area 'on and off' for several months prior to his acute admission. He was nauseous but with no vomiting. Systemic enquiry revealed only some hesitancy on urination, which had been present for several months. Past medical history included a previous duodenal ulcer, Parkinson's disease and previous pulmonary embolisms following orthopaedic injuries, for which he was taking long-term warfarin. His only other regular medications were simvastatin and ropinirole.On physical examination, the patient was apyrexial, with a firm, tender mass in the right iliac fossa. Digital rectal examination found a smoothly enlarged prostate but no other abnormality. Routine blood tests including haemoglobin, white cell count, C-reactive protein, liver function tests, and urea and electrolytes were all normal, as was dipstick urinalysis. His international normalised ratio was 2.9.Given the history of absolute constipation in association with a right iliac fossa mass, computed tomography (CT) of the thorax, abdomen and pelvis was performed as the first radiological investigation. This showed a hernia at the inferolateral aspect of the right rectus abdominis muscle containing the appendix from its caecal root (Figs 1-4). Minimal inflammation of the caecal pole was seen, along with free fluid and inflammation in the surrounding herniated fat, suggesting a degree of vascular compromise although the appendix itself did not appear significantly thickened. The hernial defect measured 21mm in diameter. There was a trace of free fluid in the pelvis but no suggestion of a tumour.The patient was listed for an emergency repair and appendicectomy. At operation, an oblique incision was made in the right iliac fossa and the external oblique aponeurosis was opened to reveal the hernial sac. The neck of the sac was exposed and the hernial defect at the edge of the right rectus abdominis muscle identified. The sac was opened to enter the peritoneal cavity. The sac contained a small amount of fluid and a macroscopically normal appearing appendix. A standard open appendicectomy was performed before closing the peritoneum. The hernial defect was closed with 2/0 Vicryl ® (Ethicon, Somerville, NJ, US) by...

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Appendicitis in a Spigelian hernia: an unusual cause for a tender right iliac fossa mass

Thomas

Avula

England

et al. 2013

annals

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“…Jamadar et al 11 did not described difficulties in assessing the lateral edge of the rectus abdominis sheath when looking for Spigelian hernias. When evaluating the inguinal region, they considered the structures in this region shallow, so that a 10 MHz linear transducer would already be effective, although in subjects with greater muscle mass a 7 MHz transducer may be needed.…”

Section: Discussionmentioning

confidence: 99%

Aspectos ultrassonográficos e anatomia da aponeurose do músculo transverso do abdome

Turatti¹,

Moura²,

Cabral³

et al. 2013

ABCD, arq. bras. cir. dig.

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-Background: Ultrasound, computed tomography, and magnetic resonance imaging of abdominal wall has increasingly been used for hernia diagnosis when clinical examination is uncertain. Anatomical study of abdominal wall along with the ultrasound of transversus abdominis muscle aponeurosis can help identify a Spigelian hernia in this region, a disease of difficult diagnosis. Aim: To compare the ultrasound findings of anterolateral wall of the abdomen, focusing on Spigelian aponeurosis, to the anatomy of abdominal wall studied in cadavers. Methods: The evaluation of the transversus abdominis aponeurosis was performed during routine ultrasound exams of the anterolateral wall of the abdomen in 90 individuals of both genders, over 25 years, and data were correlated with 60 dissections of the abdominal wall, held on cadavers.Results: Ultrasound showed no significant defects in the aponeurosis of transversus abdominis muscle in the 90 subjects studied and the width of the Spigelian aponeurosis ranged from 0.83 to 2.93 cm (mean 1.72 cm). During dissections of the transversus abdominis, some defects were found in 14 out of 60 muscles and aponeurosis studied (23.3%) and the width of the Spigelian aponeurosis ranged from 1.5 to 3.5 cm (mean 2.26 cm). Comparisons between age groups and genders evaluated by ultrasound with cadaver dissections performed were not statistically significant. Conclusion: Sonographic examinations found no defects in the aponeurosis of transversus abdominis muscle compatible with hernias, and anatomical variations and defects found during dissections were not as well accompanied by Spigelian hernias in the studied corpse. RESUMO -Racional:A avaliação da parede abdominal pela ultrassonografia, tomografia computadorizada e ressonância magnética tem sido cada vez mais indicada para auxiliar no diagnóstico das hérnias quando o exame clínico deixa dúvidas. A correlação de estudos da anatomia da parede abdominal com o exame ultrassonográfico da aponeurose do músculo transverso do abdome pode auxiliar no diagnóstico de uma hérnia desta localização, a hérnia de Spiegel, que se apresenta como doença de diagnóstico clínico difícil. Objetivo: Comparar os achados ultrassonográficos da parede anterolateral do abdome, com foco na aponeurose de Spiegel, e a anatomia da parede abdominal estudada em cadáveres não fixados. Método: A avaliação da aponeurose do músculo transverso do abdome foi realizada durante exames ultrassonográficos de rotina da parede anterolateral do abdome em 90 indivíduos de ambos os gêneros, maiores de 25 anos e estes dados foram relacionados com 60 dissecções da parede abdominal realizadas em cadáveres não fixados. Resultados: Os exames ultrassonográficos não evidenciaram falhas significativas na aponeurose do músculo transverso do abdome nos 90 indivíduos estudados e a largura das aponeuroses de Spiegel variou de 0,83 a 2,93 cm (média de 1,72 cm). Durante as dissecções do transverso do abdome foram encontradas alterações anatômicas em 14 de 60 músculos e aponeuroses estudadas (23,3%)...

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“…b), Sonogram of inguinal region (transducer position not illustrated in Fig. 4) directly over and parallel to inferior epigastric artery (E), spermatic cord short axis (arrows), external iliac artery (A), and rectus abdominis (R) 16 . …”

Section: -15mentioning

confidence: 99%

Radiological Anatomy of groin Region and radiological diagnosis of inguinal hernia.

Meenakashi¹,

R²,

B.R³

et al. 2016

IOSR

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Sonography of Inguinal Region Hernias

Abstract: Understanding healthy inguinal anatomy is essential for diagnosing inguinal region hernias. Sonography can diagnose and differentiate between various inguinal region hernias.

Cited by 112 publications

References 6 publications

Appendicitis in a Spigelian hernia: an unusual cause for a tender right iliac fossa mass

Appendicitis in a Spigelian hernia: an unusual cause for a tender right iliac fossa mass

Aspectos ultrassonográficos e anatomia da aponeurose do músculo transverso do abdome

Radiological Anatomy of groin Region and radiological diagnosis of inguinal hernia.

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