Value of ultrasound in the diagnostics of abdominal wall hernias

Self-education Ultrasonographic Association at the Department of Genetics and Pathomorphology of the Pomeranian Medical University, Szczecin, Poland. Head: Professor Jan Lubiński, MD, PhD
Correspondence: Self-education Ultrasonographic Association at the Department of Genetics and Pathomorphology of the Pomeranian Medical University, Połabska 4, 70-115 Szczecin, Poland, tel.: +48 91 466 15 32

Pediatr Med rodz Vol 10 Numer 4, p. 398–404
DOI: 10.15557/PiMR.2014.0040
ABSTRACT

The aim of this paper was to present current state of knowledge and clinical practice in the scope of imaging of anterior abdominal wall hernias. At the moment, diagnostic imaging of abdominal wall hernias utilizes such modalities as ultrasound, computed tomography and magnetic resonance. The two latter methods are not easily available, expensive and usually require filling the intestine with contrast medium or, at times, additional administration of intravenous contrast. Moreover, computed tomography exposes the patient to negative effects of ionizing radiation, and both modalities are contraindicated in claustrophobic patients or patients with renal failure when examination requires intravenous administration of contrast. Under such circumstances, ultrasound examination constitutes the basis of imaging in cases of suspected anterior abdominal wall hernias and in patients with palpable masses in such a location. It ensues from high availability, low cost, noninvasiveness and high diagnostic value of this modality as well as its applicability in all life periods – from foetal life up to old age. Other advantages of ultrasonography include: possibility to conduct the examination dynamically at patient’s bedside, including application of various tests facilitating diagnosis of small, spontaneously reducing and immovable inguinal, femoral, or umbilical hernias, hernia of the linea alba, Spigelian hernia, or various other incisional hernias that pose diagnostic challenges. Ultrasound examination allows for assessment of the size and content of the hernia sac with great precision. Some diagnosticians use the ultrasound probe to exert pressure in an attempt to place the hernia back into the abdominal cavity. Moreover, the above-mentioned method effectively visualizes any complications related to surgical reconstruction of the abdominal wall, such as pathological fluid-filled spaces, recurrent hernias, or tissue reactions to surgical material. All other pathologies of the abdominal wall that might imitate hernias are within the scope of ultrasound examination. All of the mentioned advantages of ultrasound lose significance if the doctor performing this examination lacks proper theoretical and practical background.

Keywords: abdominal wall, anterior abdominal wall hernias, incisional hernias, Spigelian hernias, ultrasound