Ultrasound assessment for abdominal and groin hernias.
Ultrasound is an excellent modality routinely used in the assessment for suspected groin hernias and other lumps within the groin and the abdomen. It can accurately perform a dynamic assessment of the hernia to see the movement of the hernia content. The article describes the role of ultrasound in hernia assessment and answers the frequently asked questions.
What is a groin hernia?
A groin hernia happens when the tissues that are supposed to stay within the abdomen (such as the intestine) protrude through an area of weakness within the abdomen wall.
What are the causes of abdominal hernia?
The most common causes of abdominal wall hernia include:
Increased pressure within the abdomen. This can happen while lifting heavy objects, repeated straining when opening the bowel or passing urine, and repeated coughing (due to long-standing chest problems or smoking, for example). All these factors can cause increased pressure within the abdomen, predisposing to abdominal wall hernia.
Pre-existing weakness within the abdominal wall- Hernias are commonly seen at a few recognised weak spots within the lower abdomen/groin. For example, in men, a weak spot is usually present in the groin near the scrotum (at the spermatic cord entry area). In addition, hernias can happen at sites of previous injury or surgery to the abdomen, as these can result in focal points of muscle weakness.
How do I know if I have a hernia?
The clinical features of a hernia include the following:
A bulge or swelling at the site of the hernia. This is most commonly seen in the groin but can be higher up in the abdomen.
The bulge tends to change in size. It is usually more prominent on standing and when there is increased pressure within the abdomen (for example, during straining or coughing).
A feeling of discomfort or dull ache within the groin. The pain can increase on bending and coughing.
The pain can sometimes be felt in the scrotum/testicles.
How to diagnose a hernia?
A groin or abdominal wall hernia diagnosis can be established using ultrasound. When performed by an experienced practitioner, ultrasound is an excellent assessment tool. It can tell the size and type of hernia and its contents and assess the movement of the hernia. The latter is referred to as dynamic ultrasound assessment.
What is a hernia dynamic ultrasound assessment?
This is a special test done using an ultrasound scan. The doctor will ask you to perform certain manoeuvres to increase the pressure within the abdomen while using ultrasound to examine the hernia. Dynamic assessment can tell if the hernia is reducible (the content of the hernia moves in and out of the abdomen freely) vs non-reducible hernias (the contents of the hernia are stuck outside the abdomen).
What are the different types of hernias?
The most common type of hernia seen within the groin is called (an inguinal hernia). These are located close to an anatomical structure called the inguinal canal. Inguinal hernias are divided into direct and indirect types, depending on their anatomical location. A less common type of hernia is called (a femoral hernia). This is seen slightly lower down within the inner/upper thigh. Ultrasound can accurately assess the type of hernia, which would be extremely useful in guiding further management.
What is an incisional hernia?
An incisional hernia happens at the site of a previous incision (surgery) to the abdominal wall. The scar at the site of previous surgery can lead to focal weakness within the abdominal wall, resulting in a hernia. This accounts for approx. 15-20% of the abdominal wall hernias.
What are the possible complications from a hernia?
The hernia usually contains tissues like fat or bowel loops. Sometimes, if the opening of the hernia is narrow or the hernia is stuck, complications can happen. These include twisting of the bowel loops within the hernia leading to blockage (intestinal obstruction) or reduced blood supply to the bowel loops within the hernia (referred to as a strangulated hernia).
What are the signs of trouble/complications from a hernia?
If you feel sudden severe pain at the hernia site or within the abdomen, this could be a sign of hernia complications. If there is an obstruction to the intestine, you may notice abdominal distension and an inability to open your bowel. The hernia itself may become more prominent, non-reducible and more tender. If you are having any of these signs, It is essential to seek urgent medical attention.
What are the other possible causes of groin swelling/pain?
There are multiple other causes of groin swelling. The most common other causes we see in our practice include enlarged lymph nodes, hip osteoarthritis, femoroacetabular impingement, iliopsoas bursitis and adductor tendinosis.
What is the treatment for groin hernia?
Treatment depends on many factors and is usually tailored to the individual. Generally, the management is either conservative or surgical. Conservative treatment includes using supporting belts and avoiding activities that can increase hernia size. Surgical treatment aims to strengthen the area of weakness within the abdominal wall and sometimes involves using special types of mesh to add support.
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