Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias

Ajogwu Ugwu; Khurram Shahzad Khan; Kit Chow

doi:doi:10.11648/j.js.20200801.18

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Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias

Ajogwu Ugwu, Khurram Shahzad Khan, Kit Chow

Published in Journal of Surgery (Volume 8, Issue 1)

Received: 29 November 2019 Accepted: 23 December 2019 Published: 3 March 2020

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Abstract

Groin hernias are a common reason to attend general surgical clinic with over 71,000 groin hernia repairs carried out in England in 2014/15. Diagnosis of groin hernias is primarily a clinical one, but a significant proportion of them are symptomatic and are not clinically palpable. There are a number of investigative options available which includes herniography, ultrasound, CT and MRI. Herniography is invasive and less sensitive to diagnose occult hernias and some radiologist would consider it, unethical & obsolete. MRI and CT scan are expensive and not always available. We evaluated the role of ultrasound in the surgical management of a cohort of patients with clinically occult groin hernia in a district general hospital. A retrospective list of patients having ultrasound examination for symptomatic groin collected from radiology department. Ultrasound which confirmed presence of hernias were identified. Ultrasound findings and clinical assessment were analyzed. In patients who underwent surgery, intra-operative findings were taken as gold standard and compared with ultrasound results. Total number of hernias included in the study was 68. Male to female distribution of patients was 3.3; 1. The mean age of participants was 42 years. In 93%, the presenting symptoms were pain, lump or combination of both. 40 patients (59%) were operated from which there was PPV of 0.90 with intraoperative findings congruent with intraoperative findings. Ultrasound is non-invasive and non-ionizing radiation imaging modality for diagnosis of impalpable groin hernias with a PPV of 90%. Morbidity associated with this modality is low. It is readily available and cheaper than MRI and CT scan with no harmful ionization radiation thereby conferring a cost benefit as well. We have shown ultrasound is a suitable tool for the initial imaging investigation of occult clinically non-palpable hernia. Our review of current literature has shown wide variance of the choice of imaging technique and the accuracy of their published report.

Published in	Journal of Surgery (Volume 8, Issue 1)
DOI	10.11648/j.js.20200801.18
Page(s)	38-42
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Groin Hernia, Femoral Hernia, Inguinal Hernia, Occult Hernia, Ultrasound

References

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[2]	NHS Digital. Hospital Episode Statistics (Procedures and Interventions), 2016/17.
[3]	Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362: 1561–1571. https://doi.org/10.1016/S0140-6736%2803%2914746-0.
[4]	Moreno-Egea, A., Girela, E., Canteras, M. et al. Accuracy of clinical diagnosis of inguinal and femoral hernia and its usefulness for indicating laparoscopic surgery Hernia (2000) 4: 23. https://doi.org/10.1007/BF01230587.
[5]	Alam, A., Nice, C. & Uberoi, R. The accuracy of ultrasound in the diagnosis of clinically occult groin hernias in adults Eur Radiol 2005 15: 2457. https://doi.org/10.1007/s00330-005-2825-7.
[6]	Robinson, A., Light, D. and Nice, C. (2013), Meta-analysis of Sonography in the Diagnosis of Inguinal Hernias. Journal of Ultrasound in Medicine, 32: 339-346. doi: 10.7863/jum.2013.32.2.339.
[7]	Philip Robinson, Elizabeth Hensor, Mark J. Lansdown et al Inguinofemoral Hernia: Accuracy of Sonography in Patients with Indeterminate Clinical Features American Journal of Roentgenology. 2006; 187: 1168-1178. 10.2214/AJR.05.1251.
[8]	Djuric-Stefanovic A, Saranovic D, Ivanovic A et al The accuracy of ultrasonography in classification of groin hernias according to the criteria of the unified classification system. Hernia. 2008 Aug; 12 (4): 395-400. doi: 10.1007/s10029-008-0352-6. Epub 2008 Feb 22.
[9]	Lilly MC, Arregui ME Ultrasound of the inguinal floor for evaluation of hernias Surg Endosc. 2002 Apr; 16 (4): 659-62. Epub 2001 Dec 17.
[10]	Depasquale R, Landes C, Doyle G Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained. Clin Radiol. 2009 Jun; 64 (6): 608-14. doi: 10.1016/j.crad.2008.11.006. Epub 2009 Apr 10.
[11]	Thomas Grant, DO, Erin Neuschler, MD, Wilson Hartz III, MD Groin Pain in Women Use of Sonography to Detect Occult Hernias J Ultrasound Med 2011; 30: 1701–1707.
[12]	Miller J, Cho J, Michael MJ et al Role of Imaging in the Diagnosis of Occult Hernias. JAMA Surg. 2014; 149 (10): 1077–1080. doi: 10.1001/jamasurg.2014.484.
[13]	Philip Robinson, Elizabeth Hensor, Mark J. Lansdown, N. Simon Ambrose, and Anthony H. Chapman Inguinofemoral Hernia: Accuracy of Sonography in Patients with Indeterminate Clinical Features American Journal of Roentgenology 2006 187: 5, 1168-1178.
[14]	Korenkov, M., Paul, A. and Troidl, H. (1999), Color duplex sonography: diagnostic tool in the differentiation of inguinal hernias Journal of Ultrasound in Medicine, 18: 565-568. doi: 10.7863/jum.1999.18.8.565.
[15]	E. Alabraba, E. Psarelli, K. Meakin, M. Quinn, M. Leung, M. Hartley, N. Howes The role of ultrasound in the management of patients with occult groin hernias International Journal of Surgery Volume 12, Issue 9 2014 Pages 918-922 ISSN 1743-9191 https://doi.org/10.1016/j.ijsu.2014.07.266.
[16]	Weyhe, D., Tabriz, N., Sahlmann, B., et al. (2017). Risk factors for perioperative complications in inguinal hernia repair – a systematic review. Innovative Surgical Sciences, 2 (2), pp. 47-52. Retrieved 14 Dec. 2019, from doi: 10.1515/iss-2017-0008.

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APA Style

Ajogwu Ugwu, Khurram Shahzad Khan, Kit Chow. (2020). Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias. Journal of Surgery, 8(1), 38-42. https://doi.org/10.11648/j.js.20200801.18

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ACS Style

Ajogwu Ugwu; Khurram Shahzad Khan; Kit Chow. Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias. J. Surg. 2020, 8(1), 38-42. doi: 10.11648/j.js.20200801.18

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AMA Style

Ajogwu Ugwu, Khurram Shahzad Khan, Kit Chow. Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias. J Surg. 2020;8(1):38-42. doi: 10.11648/j.js.20200801.18

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@article{10.11648/j.js.20200801.18,
  author = {Ajogwu Ugwu and Khurram Shahzad Khan and Kit Chow},
  title = {Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias},
  journal = {Journal of Surgery},
  volume = {8},
  number = {1},
  pages = {38-42},
  doi = {10.11648/j.js.20200801.18},
  url = {https://doi.org/10.11648/j.js.20200801.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200801.18},
  abstract = {Groin hernias are a common reason to attend general surgical clinic with over 71,000 groin hernia repairs carried out in England in 2014/15. Diagnosis of groin hernias is primarily a clinical one, but a significant proportion of them are symptomatic and are not clinically palpable. There are a number of investigative options available which includes herniography, ultrasound, CT and MRI. Herniography is invasive and less sensitive to diagnose occult hernias and some radiologist would consider it, unethical & obsolete. MRI and CT scan are expensive and not always available. We evaluated the role of ultrasound in the surgical management of a cohort of patients with clinically occult groin hernia in a district general hospital. A retrospective list of patients having ultrasound examination for symptomatic groin collected from radiology department. Ultrasound which confirmed presence of hernias were identified. Ultrasound findings and clinical assessment were analyzed. In patients who underwent surgery, intra-operative findings were taken as gold standard and compared with ultrasound results. Total number of hernias included in the study was 68. Male to female distribution of patients was 3.3; 1. The mean age of participants was 42 years. In 93%, the presenting symptoms were pain, lump or combination of both. 40 patients (59%) were operated from which there was PPV of 0.90 with intraoperative findings congruent with intraoperative findings. Ultrasound is non-invasive and non-ionizing radiation imaging modality for diagnosis of impalpable groin hernias with a PPV of 90%. Morbidity associated with this modality is low. It is readily available and cheaper than MRI and CT scan with no harmful ionization radiation thereby conferring a cost benefit as well. We have shown ultrasound is a suitable tool for the initial imaging investigation of occult clinically non-palpable hernia. Our review of current literature has shown wide variance of the choice of imaging technique and the accuracy of their published report.},
 year = {2020}
}

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TY - JOUR
T1 - Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias
AU - Ajogwu Ugwu
AU - Khurram Shahzad Khan
AU - Kit Chow
Y1 - 2020/03/03
PY - 2020
N1 - https://doi.org/10.11648/j.js.20200801.18
DO - 10.11648/j.js.20200801.18
T2 - Journal of Surgery
JF - Journal of Surgery
JO - Journal of Surgery
SP - 38
EP - 42
PB - Science Publishing Group
SN - 2330-0930
UR - https://doi.org/10.11648/j.js.20200801.18
AB - Groin hernias are a common reason to attend general surgical clinic with over 71,000 groin hernia repairs carried out in England in 2014/15. Diagnosis of groin hernias is primarily a clinical one, but a significant proportion of them are symptomatic and are not clinically palpable. There are a number of investigative options available which includes herniography, ultrasound, CT and MRI. Herniography is invasive and less sensitive to diagnose occult hernias and some radiologist would consider it, unethical & obsolete. MRI and CT scan are expensive and not always available. We evaluated the role of ultrasound in the surgical management of a cohort of patients with clinically occult groin hernia in a district general hospital. A retrospective list of patients having ultrasound examination for symptomatic groin collected from radiology department. Ultrasound which confirmed presence of hernias were identified. Ultrasound findings and clinical assessment were analyzed. In patients who underwent surgery, intra-operative findings were taken as gold standard and compared with ultrasound results. Total number of hernias included in the study was 68. Male to female distribution of patients was 3.3; 1. The mean age of participants was 42 years. In 93%, the presenting symptoms were pain, lump or combination of both. 40 patients (59%) were operated from which there was PPV of 0.90 with intraoperative findings congruent with intraoperative findings. Ultrasound is non-invasive and non-ionizing radiation imaging modality for diagnosis of impalpable groin hernias with a PPV of 90%. Morbidity associated with this modality is low. It is readily available and cheaper than MRI and CT scan with no harmful ionization radiation thereby conferring a cost benefit as well. We have shown ultrasound is a suitable tool for the initial imaging investigation of occult clinically non-palpable hernia. Our review of current literature has shown wide variance of the choice of imaging technique and the accuracy of their published report.
VL - 8
IS - 1
ER -

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Author Information

Ajogwu Ugwu

Department of Surgery, University Hospital Wishaw, Wishaw, UK
Khurram Shahzad Khan

Department of Surgery, NHS Greater Glasgow & Clyde, Glasgow, UK
Kit Chow

Department of Radiology, Sherwood Forest Hospitals, Nottinghamshire, UK

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APA Style

Ajogwu Ugwu, Khurram Shahzad Khan, Kit Chow. (2020). Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias. Journal of Surgery, 8(1), 38-42. https://doi.org/10.11648/j.js.20200801.18

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ACS Style

Ajogwu Ugwu; Khurram Shahzad Khan; Kit Chow. Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias. J. Surg. 2020, 8(1), 38-42. doi: 10.11648/j.js.20200801.18

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AMA Style

Ajogwu Ugwu, Khurram Shahzad Khan, Kit Chow. Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias. J Surg. 2020;8(1):38-42. doi: 10.11648/j.js.20200801.18

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@article{10.11648/j.js.20200801.18,
  author = {Ajogwu Ugwu and Khurram Shahzad Khan and Kit Chow},
  title = {Accuracy of Ultrasound as a Diagnostic Tool for the Assessment of Occult Groin Hernias},
  journal = {Journal of Surgery},
  volume = {8},
  number = {1},
  pages = {38-42},
  doi = {10.11648/j.js.20200801.18},
  url = {https://doi.org/10.11648/j.js.20200801.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200801.18},
  abstract = {Groin hernias are a common reason to attend general surgical clinic with over 71,000 groin hernia repairs carried out in England in 2014/15. Diagnosis of groin hernias is primarily a clinical one, but a significant proportion of them are symptomatic and are not clinically palpable. There are a number of investigative options available which includes herniography, ultrasound, CT and MRI. Herniography is invasive and less sensitive to diagnose occult hernias and some radiologist would consider it, unethical & obsolete. MRI and CT scan are expensive and not always available. We evaluated the role of ultrasound in the surgical management of a cohort of patients with clinically occult groin hernia in a district general hospital. A retrospective list of patients having ultrasound examination for symptomatic groin collected from radiology department. Ultrasound which confirmed presence of hernias were identified. Ultrasound findings and clinical assessment were analyzed. In patients who underwent surgery, intra-operative findings were taken as gold standard and compared with ultrasound results. Total number of hernias included in the study was 68. Male to female distribution of patients was 3.3; 1. The mean age of participants was 42 years. In 93%, the presenting symptoms were pain, lump or combination of both. 40 patients (59%) were operated from which there was PPV of 0.90 with intraoperative findings congruent with intraoperative findings. Ultrasound is non-invasive and non-ionizing radiation imaging modality for diagnosis of impalpable groin hernias with a PPV of 90%. Morbidity associated with this modality is low. It is readily available and cheaper than MRI and CT scan with no harmful ionization radiation thereby conferring a cost benefit as well. We have shown ultrasound is a suitable tool for the initial imaging investigation of occult clinically non-palpable hernia. Our review of current literature has shown wide variance of the choice of imaging technique and the accuracy of their published report.},
 year = {2020}
}

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