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Obilat S, El Graini S, Allali N, Chat L, Aqqaoui L, Ettayebi F, El Haddad S. Amyand's hernia in a 3-month-old infant: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241246876. [PMID: 38606031 PMCID: PMC11008343 DOI: 10.1177/2050313x241246876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024] Open
Abstract
Amyand's hernia is a rare condition characterized by an inguinal hernia containing the appendix, which can lead to complications. It is more common in children and it can be challenging to diagnose due to its location, often being mistaken for other conditions like strangulated hernias, orchitis-epididymitis, or testicular torsion. Imaging, including computed tomography and sonography, plays an important role in diagnosis, which is usually made intraoperatively. A case concerning a 3-month-old boy with a large acute scrotum that had been evolving for 4 days was presented. Clinical examination revealed a hard inguinal mass and a large scrotum with signs of inflammation. An inguinoscrotal ultrasound found a herniated appendix, suggesting the diagnosis of Amyand's hernia, which was confirmed after surgery.
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Affiliation(s)
- Samia Obilat
- Pediatric Radiology Department, Children’s Hospital, University Mohammed V, Rabat, Morocco
| | - Soumya El Graini
- Pediatric Radiology Department, Children’s Hospital, University Mohammed V, Rabat, Morocco
| | - Nazik Allali
- Pediatric Radiology Department, Children’s Hospital, University Mohammed V, Rabat, Morocco
| | - Latifa Chat
- Pediatric Radiology Department, Children’s Hospital, University Mohammed V, Rabat, Morocco
| | - Loubna Aqqaoui
- Pediatric Surgery Department, Children’s Hospital, University Mohammed V, Rabat, Morocco
| | - Fouad Ettayebi
- Pediatric Surgery Department, Children’s Hospital, University Mohammed V, Rabat, Morocco
| | - Siham El Haddad
- Pediatric Radiology Department, Children’s Hospital, University Mohammed V, Rabat, Morocco
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Treanor L, Drury A, Egri C, Barrett S. "Rule out appendicitis": a Canadian emergency radiology perspective on medicolegal risks, imaging pitfalls, and strategies to improve care. Emerg Radiol 2024; 31:239-249. [PMID: 38366206 DOI: 10.1007/s10140-024-02214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/09/2024] [Indexed: 02/18/2024]
Abstract
We provide a unique Canadian perspective on the medicolegal risks associated with imaging acute appendicitis, incorporating data requested from the Canadian Medical Protective Association (CMPA) on closed medicolegal cases over the past decade. We include a review of current clinical and imaging guidelines in the diagnosis and management of this common emergency room presentation. A case-based approach is implemented in this article to explore ways to mitigate potential errors in the diagnosis of acute appendicitis.
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Affiliation(s)
- Lee Treanor
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Anne Drury
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Csilla Egri
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Barrett
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Ghafoor S, Tognella A, Stocker D, Hötker AM, Kaniewska M, Sartoretti T, Euler A, Vonlanthen R, Bueter M, Alkadhi H. Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. Hernia 2023; 27:1253-1261. [PMID: 37410196 PMCID: PMC10533612 DOI: 10.1007/s10029-023-02830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Inguinal hernias are mainly diagnosed clinically, but imaging can aid in equivocal cases or for treatment planning. The purpose of this study was to evaluate the diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. METHODS This single-center retrospective study reviewed all consecutive Valsalva-CT studies between 2018 and 2019. A composite clinical reference standard including surgery was used. Three blinded, independent readers (readers 1-3) reviewed the CT images and scored the presence and type of inguinal hernia. A fourth reader measured hernia size. Interreader agreement was quantified with Krippendorff's α coefficients. Sensitivity, specificity, and accuracy of Valsalva-CT for the detection of inguinal hernias was computed for each reader. RESULTS The final study population included 351 patients (99 women) with median age 52.2 years (interquartile range (IQR), 47.2, 68.9). A total of 381 inguinal hernias were present in 221 patients. Sensitivity, specificity, and accuracy were 85.8%, 98.1%, and 91.5% for reader 1, 72.7%, 92.5%, and 81.8% for reader 2, and 68.2%, 96.3%, and 81.1% for reader 3. Hernia neck size was significantly larger in cases correctly detected by all three readers (19.0 mm, IQR 13, 25), compared to those missed by all readers (7.0 mm, IQR, 5, 9; p < 0.001). Interreader agreement was substantial (α = 0.723) for the diagnosis of hernia and moderate (α = 0.522) for the type of hernia. CONCLUSION Valsalva-CT shows very high specificity and high accuracy for the diagnosis of inguinal hernia. Sensitivity is only moderate which is associated with missed smaller hernias.
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Affiliation(s)
- S Ghafoor
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - A Tognella
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - D Stocker
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A M Hötker
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Kaniewska
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - T Sartoretti
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A Euler
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - R Vonlanthen
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - H Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Fouda JC, Owon'Abessolo PF, Nyanit BD, Mekeme Mekeme JB, Savom P, Ranibel A, Mbassi AA, Bwelle G, Bang GA, Fouda PJ, Mouafo Tambo F, Essomba A. A case of Amyand hernia at the Central Hospital of Yaounde and review of the literature. Surg Case Rep 2023; 9:80. [PMID: 37191879 DOI: 10.1186/s40792-023-01632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/23/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Amyand's hernia is defined as an inguinal hernia, containing the appendix in the hernia sac. It is a rare form of hernia. Its management is increasingly codified. CLINICAL HISTORY A 5-year-old patient with a non-remarkable past history was brought for consultation with an intermittent inguino-scrotal swelling and discomfort. Clinical examination revealed a non-tender inguino-scrotal swelling with positive transillumination. A conclusion of a communicating hydrocele was made; hence, an indication for surgery. Per operatively, we had as findings the appendix present within, and linked to the hernia sac. We performed an appendectomy and a high ligation of the hernia sac. The post-operative evolution was favourable. Anatomopathological analysis revealed a catarrhal appendix. CONCLUSION Amyand's hernia remains a rare pathology that can be seen in children with a persistent peritoneo-vaginal canal. Dissection of the hernia sac must be carried out carefully since it is most often discovered intraoperatively and accidental injury to the appendix, which is attached to the wall of the hernia sac can lead to serious complications.
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Affiliation(s)
- J C Fouda
- Yaounde Central Hospital, Yaounde, Cameroon.
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | | | - Bob Dorcas Nyanit
- Yaounde Central Hospital, Yaounde, Cameroon
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Junior Barthelemy Mekeme Mekeme
- Yaounde Central Hospital, Yaounde, Cameroon
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - P Savom
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - A Ranibel
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - A A Mbassi
- Yaounde Central Hospital, Yaounde, Cameroon
| | - G Bwelle
- Yaounde Central Hospital, Yaounde, Cameroon
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - G A Bang
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - P J Fouda
- Yaounde Central Hospital, Yaounde, Cameroon
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Faustin Mouafo Tambo
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - A Essomba
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
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Cakir IM, Bekci T, Aslan S, Eryuruk U. Comparison of Doppler Ultrasound and Clinical Features of Patients With and Without Femoral Hernia in Lower Extremity Venous Insufficiency Patients. Ultrasound Q 2022; 38:322-327. [PMID: 36398886 DOI: 10.1097/ruq.0000000000000630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
ABSTRACT In this study, we aim to evaluate Doppler ultrasound (US) and clinical features of patients with and without femoral hernia (FH) in lower extremity chronic venous insufficiency (CVI) patients.We retrospectively analyzed prospectively collected data of 1364 limbs with the CVI suspected. Femoral hernia was detected in 32 of the limbs, and the control group was formed with 32 limbs without FH. All limbs were evaluated with Valsalva maneuver and augmentation method to detect venous reflux in FH group. Venous reflux rates in the Doppler US, venous clinical severity scores (VCSSs), and clinical classes of Clinical-Etiology-Anatomy-Pathophysiology classification were compared statistically in both groups.The mean VCSS was 3.87 ± 0.74 in the FH group and 2.68 ± 0.65 in the control group, which was statistically significant ( P = 0.04). In the more severe clinical classes of Clinical-Etiology-Anatomy-Pathophysiology (C4-6), the number of limbs in the FH group was higher than in the control group (8 and 4, respectively). Doppler US examinations showed venous reflux in 22 of 32 limbs in the FH group and 19 of 32 patients in the control group, and there was a statistically significant difference ( P = 0.029). In the FH group, reflux could be shown only by augmentation method in the vast majority of limbs (16 of 22, 73%).In conclusion, VCSS and reflux rates are higher in limbs with CVI accompanied by FH. In addition, FH may cause false negative results in the evaluation of CVI. The use of augmentation method in limbs with FH can help avoid false negatives.
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Affiliation(s)
- Ismet Mirac Cakir
- From the Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | | | - Serdar Aslan
- From the Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Uluhan Eryuruk
- From the Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
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Garcia EM, Pietryga JA, Kim DH, Fowler KJ, Chang KJ, Kambadakone AR, Korngold EK, Liu PS, Marin D, Moreno CC, Panait L, Santillan CS, Weinstein S, Wright CL, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Hernia. J Am Coll Radiol 2022; 19:S329-S340. [PMID: 36436960 DOI: 10.1016/j.jacr.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Abdominopelvic hernias are common clinical entities composed of a wide variety of congenital, traumatic, and iatrogenic etiologies. Any weakness in the body wall may result in hernia of cavity contents with concomitant risks of morbidity and mortality. Presentations may be specific, palpable body wall mass/bulge, or vague, nonspecific pain through bowel obstruction. This document focuses on initial imaging of the adult population with signs of symptoms prompting suspicion of abdominopelvic hernia. Imaging of the abdomen and pelvis to evaluate defects is essential for prompt diagnosis and treatment. Often CT and ultrasound are the first-line modalities to quickly evaluate the abdomen and pelvis, providing for accurate diagnoses and management of patients. MRI protocols may be useful as first-line imaging studies, especially in patients with orthopedic instrumentation. Although often performed, abdominal radiographs and fluorographic procedures may provide indirect evidence of hernias but are usually not indicated for initial diagnosis of hernia. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Board Member, Taubman Museum of Art.
| | - Jason A Pietryga
- Division Chief, Emergency Radiology at UNC Chapel Hill, Chapel Hill North Carolina; and University of Alabama at Birmingham, Birmingham, Alabama
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; and Vice-Chair of Education, University of Wisconsin Department of Radiology
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; Chair ACR LI-RADS; Division Chief, SAR Portfolio Director, RSNA Radiology Senior Deputy Editor
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Section Chief of Abdominal Imaging, Director of MRI, Chair of Committee on C-RADS
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital and Medical Director, Martha's Vineyard Hospital Imaging
| | - Elena K Korngold
- Section Chief, Body Imaging/Chair, Department of Radiology Promotion and Tenure Committee; Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Lucian Panait
- President, Minnesota Hernia Center, Minneapolis, Minnesota; American College of Surgeons; American Hernia Society (member of the Technology and Value Assessment Committee); Practice Advisory Committee Member, American Hernia Society
| | - Cynthia S Santillan
- Vice-Chair of Clinical Operations, Department of Radiology, University of California San Diego, San Diego, California
| | | | | | - Jennifer Zreloff
- Georgia, Primary Care Physician, Emory University, Atlanta, Georiga; Medical Director, Seavey General Medicine Clinic; Assistant Director of Innovation Seavey Comprehensive Internal Medicine Clinic, Emory University, Atlanta, Georgia
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Section Chief Abdominal Imaging, Director of MRI and CT
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Gök MA, Büyüközsoy AK, Kafadar MT. The sensitivity of ultrasound in the clinical diagnosis of inguinal hernias in adults: a comparative study. J Ultrasound 2022; 25:655-658. [PMID: 35014003 PMCID: PMC9402849 DOI: 10.1007/s40477-021-00641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Ultrasonography (US) is a non-invasive, non-ionizing radiation modality highly successful at diagnosing inguinal hernia. The aim of this study is to demonstrate the accuracy of ultrasound in evaluating defects of fascia in inguinal hernias and compare with surgical findings. MATERIAL AND METHODS A total of 33 patients with a sonographic diagnosis of an inguinal hernia are included to study. After US, all patients underwent a blinded surgery and the surgical findings are compared with the US results. RESULTS The sensitivity of US was found to be 100% and 80% for indirect and direct types, respectively. The mean size of the defect was found to be 22 mm (max: 70 mm, min: 6 mm) with US; and 27 mm (max: 50 mm, min: 4 mm) at surgery. The size of defects at US and in surgery were correlated with each other (p = 0.001).
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Affiliation(s)
- Mehmet Ali Gök
- Clinic of General Surgery, Kartal Dr Lütfi Kırdar City Hospital, Health Sciences University, Istanbul, Turkey
| | | | - Mehmet Tolga Kafadar
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
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Pre- and postsurgical imaging findings of abdominal wall hernias based on the European Hernia Society (EHS) classification. Abdom Radiol (NY) 2021; 46:5055-5071. [PMID: 34292364 DOI: 10.1007/s00261-021-03211-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022]
Abstract
Abdominal wall hernias are common and can present as technical challenges to surgeons. When large, hernias diminish quality of life. Various classifications of incisional hernias have been proposed; however, there are many terms, sometimes causing confusion (1). Radiologists must know the normal anatomy of the abdominal wall, the CT protocol, and what if any maneuvers can be performed to better identify an abdominal wall defect. The description of the radiological approach for primary and incisional wall hernias is based on the 2007 European Hernia Society classification, with particular emphasis on presurgical and postsurgical imaging findings. This classification provides a simple and reproducible method to describe hernias to offer proper surgical management. We highlight this classification so that radiologists and surgeons can have a unified language.
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9
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Incidental findings in and around the prostate on prostate MRI: a pictorial review. Insights Imaging 2021; 12:37. [PMID: 33738590 PMCID: PMC7973355 DOI: 10.1186/s13244-021-00979-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/19/2021] [Indexed: 02/07/2023] Open
Abstract
Prostate MRI has seen rapid growth in use in recent years as an advanced diagnostic modality to detect focal areas of clinically significant prostate cancer, to identify an area for targeted biopsy and to guide management and surveillance. The increase in use has also led to increased diagnosis of incidental lesions arising from structures around the prostate. These incidental findings may be related to the genitourinary system or non- genitourinary system and may have a benign aetiology which needs no additional follow-up, or it may require surveillance and management. The field of view in a multiparametric prostate MRI includes other pelvic organs, neurovascular bundles, bowel, lymph nodes and bones. Being familiar with standard MRI characteristics and a sound knowledge of anatomy of the prostate and surrounding structures can help in distinguishing normal anatomy from pathology. Given that patients undertaking a prostate MRI are usually a cohort with increased anxiety from their known or suspicion of prostate cancer, it is important that radiologists are familiar with these common incidental findings to minimise anxiety to the patient, have a well-informed discussion with the referring clinician and reduce costs associated with unnecessary further testing and follow-up of benign incidental findings. Additionally, being able to diagnose more serious incidental pathologies early can be life-saving and potentially significantly alter patient management.
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Picasso R, Pistoia F, Zaottini F, Airaldi S, Perez MM, Pansecchi M, Tovt L, Sanguinetti S, Möller I, Bruns A, Martinoli C. High-resolution ultrasound of spigelian and groin hernias: a closer look at fascial architecture and aponeurotic passageways. J Ultrason 2021; 21:53-62. [PMID: 33791116 PMCID: PMC8008201 DOI: 10.15557/jou.2021.0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/28/2020] [Indexed: 11/22/2022] Open
Abstract
From the clinical point of view, a proper diagnosis of spigelian, inguinal and femoral hernias may be relevant for orienting the patient's management, as these conditions carry a different risk of complications and require specific approaches and treatments. Imaging may play a significant role in the diagnostic work-up of patients with suspected abdominal hernias, as the identification and categorization of these conditions is often unfeasible on clinical ground. Ultrasound imaging is particularly suited for this purpose, owing to its dynamic capabilities, high accuracy, low cost and wide availability. The main limitation of this technique consists of its intrinsic operator dependency, which tends to be higher in difficult-to-scan areas such as the groin because of its intrinsic anatomic complexity. An in-depth knowledge of the anatomy of the lower abdominal wall is, therefore, an essential prerequisite to perform a targeted ultrasound examination and discriminate among different types of regional hernias. The aim of this review is to provide a detailed analysis of the fascial architecture and aponeurotic passageways of the abdominal wall through which spigelian, inguinal and femoral hernias extrude, by means of schematic drawings, ultrasound images and video clips. A reasoned landmark-based ultrasound scanning technique is described to allow a prompt and reliable identification of these pathologic conditions.
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Affiliation(s)
- Riccardo Picasso
- Department of Health Science (DISSAL), Università di Genova, Genova, Italy
- UO Radiologia - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federico Pistoia
- Department of Health Science (DISSAL), Università di Genova, Genova, Italy
- UO Radiologia - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federico Zaottini
- Department of Health Science (DISSAL), Università di Genova, Genova, Italy
- UO Radiologia - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Maribel Miguel Perez
- Unidad de Anatomía y Embriología Humana, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina y Ciencias de la Salud (Campus de Bellvitge), Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Michelle Pansecchi
- Department of Health Science (DISSAL), Università di Genova, Genova, Italy
- UO Radiologia - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Tovt
- Department of Health Science (DISSAL), Università di Genova, Genova, Italy
- UO Radiologia - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sara Sanguinetti
- Department of Health Science (DISSAL), Università di Genova, Genova, Italy
- UO Radiologia - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Alessandra Bruns
- Division of Rheumatology, Sherbrooke University, Sherbrooke, Canada
| | - Carlo Martinoli
- Department of Health Science (DISSAL), Università di Genova, Genova, Italy
- UO Radiologia - IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Melwani R, Malik SJ, Arija D, Sial I, Bajaj AK, Anwar A, Hashmi AA. Body Mass Index and Inguinal Hernia: An Observational Study Focusing on the Association of Inguinal Hernia With Body Mass Index. Cureus 2020; 12:e11426. [PMID: 33312822 PMCID: PMC7727769 DOI: 10.7759/cureus.11426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective An inguinal hernia is a common condition associated with advanced age, male gender, smoking, connective tissue disorder, and factors responsible for increased intra-abdominal pressure. This study aimed to observe the relationship of body mass index with the development of inguinal hernia in males and females. Methodology This cross-sectional descriptive study using a non-probability convenient sampling technique was carried out at Al-Tibri medical college and hospital, Karachi, Pakistan. A total of 82 patients were selected: 78 males and four females. The ethical approval for the study was taken from Institutional Research and Ethical Committee. Inclusion criteria based on the patient age above 40 of either gender with complaints of pain in the groin region with clinical findings like swelling and tenderness. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Inc., Armonk, USA). Results The mean age of 82 patients diagnosed with an inguinal hernia on a clinical basis was 47.41 ± 15.49 years. The mean height was 67.09 ± 3.95 inches. The mean weight was 63.5 ± 6.77 kg. The mean BMI was 22.07 ± 2.17 kg/m2. Seventy-eight (96.06%) were males, and four (5.9%) were females. Thirty-four (41.5%) patients were diagnosed with right inguinal hernia, 34 (41.5%) - with a left inguinal hernia, and 14 (17.1%) - with a bilateral inguinal hernia. BMI was normal in 68 (86.3%) and low in 14 (20.55%) patients. Our study indicated that patients with normal BMI were more likely to suffer from inguinal hernia than patients with low BMI. Conclusion This study concluded that the normal body mass index was associated with a high occurrence of inguinal hernia among the genders. The normal body mass index in males exhibits more inguinal hernia chances than a low body mass index. It was observed that the frequency of unilateral right inguinal hernia is higher than bilateral. Similarly, males are more affected than females.
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Affiliation(s)
- Rekha Melwani
- General Surgery, Al-Tibri Medical College and Hospital, Isra University, Karachi, PAK
| | - Sadaf Jabeen Malik
- General Surgery, Al-Tibri Medical College and Hospital, Isra University, Karachi, PAK
| | - Dharmoon Arija
- General Surgery, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Ihsanullah Sial
- General Surgery, Al-Tibri Medical College and Hospital, Isra University, Karachi, PAK
| | - Ajay Kumar Bajaj
- General Surgery, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Adnan Anwar
- Physiology, Al-Tibri Medical College and Hospital, Isra university, Karachi, PAK
| | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
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Papaconstantinou D, Garoufalia Z, Kykalos S, Nastos C, Tsapralis D, Ioannidis O, Michalinos A, Chatzimavroudis G, Schizas D. Implications of the presence of the vermiform appendix inside an inguinal hernia (Amyand's hernia): a systematic review of the literature. Hernia 2020; 24:951-959. [PMID: 32451789 DOI: 10.1007/s10029-020-02215-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/06/2020] [Indexed: 12/08/2022]
Abstract
PURPOSE To identify and sum all available evidence pertaining to the management of Amyand's hernia (AH). METHODS A systematic search of the MedLine, Scopus, and Google Scholar databases was performed for studies published until January 2020. RESULTS In total, 111 studies incorporating 161 patients were identified, 96 (86.4%) being case reports, 11 (9.9%) case series, and 4 (3.7%) retrospective patient cohorts. Mean patient age was 58.5 ± 19.6 years with 136 (83.9%) being males and 25 (16.1%) females. Furthermore, 149 (92.5%) cases were right-sided hernias while 12 (7.5%) cases were left-sided. Overall, 62.3% of patients presented emergently and 77.3% of patients' cohort were eventually diagnosed with incarcerated AH. Preoperative diagnosis of AH was established in 23.1% of patients and was achieved either by ultrasound (25%) or CT scan (75%). Operative findings consisted of normal appendix in 73 (45.4%) cases, uncomplicated appendicitis in 62 (38.5%) patients, and perforated appendix in 26 (16.1%). Regarding patients with appendicitis, mesh placement was reported for 17 (21.2%), herniorrhaphy was performed for 51 (63.7%) while 12 (15.1%) patients did not undergo hernia repair during the initial operation. Mesh utilization rates were significantly higher in patients with a normal appendix. Seven cases involved AH containing appendiceal neoplasms. Thirteen cases (8.6%) of postoperative complications were documented and a single case of postoperative death. CONCLUSION AH is a rare type of inguinal hernia usually complicated by appendicitis. Hernia reconstruction should be tailored to each patient individually according to the extent of inguinal canal inflammation.
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Affiliation(s)
- D Papaconstantinou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece.
| | - Z Garoufalia
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - S Kykalos
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - C Nastos
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece
| | - D Tsapralis
- Surgical Department, General Hospital of Ierapetra, Ierapetra, Greece
| | - O Ioannidis
- Fourth Department of Surgery, Aristotle University of Thessaloniki, General Hospital George Papanikolaou, Thessaloniki, Greece
| | - A Michalinos
- Department of Anatomy, European University of Cyprus, Nicosia, Cyprus
| | - G Chatzimavroudis
- Second Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - D Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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13
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Ultrasound diagnosis of acute appendicitis complicating De Garengeot's hernia. J Ultrasound 2020; 24:205-209. [PMID: 32356219 DOI: 10.1007/s40477-020-00466-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022] Open
Abstract
De Garengeot's hernia is a rare condition defined by the herniation of the vermiform appendix within a femoral hernia sac. We report a case of an 80-year-old woman admitted to our emergency department complaining of pain in the right groin. This symptomatology, present for 2 days, increased in the following 12 h. Ultrasonography (US) and contrast-enhanced computed tomography (CECT) were performed, which showed the herniation of the vermiform appendix in the femoral hernia sac. Doppler ultrasonography (DUS) and CECT were the fundamental imaging investigations for this diagnosis. The management of De Garengeot's hernia is surgical through herniorrhaphy, which makes it possible to repair the femoral hernia and perform an appendicectomy in case of appendicitis.
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14
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Chen D. Laugier’s Hernia Concomitant with Femoral Hernia: a Case Report. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Abstract
Both epiploic appendagitis and femoral herniae are rare diagnoses individually. No radiological cases of a patient having epiploic appendagitis within a femoral hernia have been documented in the literature. We present a case of a 65-year-old patient who underwent clinical work-up for a tender left groin lump. When undergoing a CT scan for investigating possible lymphadenopathy, she was found to have epiploic appendagitis contained within an incarcerated left sided femoral hernia. In this case report, we review the relevant anatomy, aetiology, patient demographics, as well as clinical and imaging findings and management.
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Affiliation(s)
- Donald McArthur
- Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Claire McArthur
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom
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16
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Yamaoka T, Kurihara K, Kido A, Togashi K. Four "fine" messages from four kinds of "fine" forgotten ligaments of the anterior abdominal wall: have you heard their voices? Jpn J Radiol 2019; 37:750-772. [PMID: 31522387 DOI: 10.1007/s11604-019-00869-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
On the posterior aspect of the anterior abdominal wall, there are four kinds of "fine" ligaments. They are: the round ligament of the liver, median umbilical ligament (UL), a pair of medial ULs, and a pair of lateral ULs. Four of them (the round ligament, median UL, and paired medial ULs) meet at the umbilicus because they originate from the contents of the umbilical cord. The round ligament of the liver originates from the umbilical vein, the medial ULs from the umbilical arteries, and the median UL from the urachus. These structures help radiologists identify right-sided round ligament (RSRL) (a rare, but surgically important normal variant), as well as to differentiate groin hernias. The ligaments can be involved in inflammation; moreover, tumors can arise from them. Unique symptoms such as umbilical discharge and/or location of pathologies relating to their embryology are important in diagnosing their pathologies. In this article, we comprehensively review the anatomy, embryology, and pathology of the "fine" abdominal ligaments and highlight representative cases with emphasis on clinical significance.
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Affiliation(s)
- Toshihide Yamaoka
- Department of Diagnostic Imaging and Interventional Radiology, Kyoto Katsura Hospital, 17 Yamada-Hirao, Nishikyo, Kyoto, 615-8256, Japan.
| | - Kensuke Kurihara
- Department of Diagnostic Imaging and Interventional Radiology, Kyoto Katsura Hospital, 17 Yamada-Hirao, Nishikyo, Kyoto, 615-8256, Japan
| | - Aki Kido
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara, Sakyo, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara, Sakyo, Kyoto, Japan
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17
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Radiologic Reporting and Interpretation of Occult Inguinal Hernia. J Am Coll Surg 2019; 227:489-495. [PMID: 30368312 DOI: 10.1016/j.jamcollsurg.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/23/2018] [Accepted: 08/06/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inguinal hernias are common entities. Occult inguinal hernias are difficult to diagnose on examination and can cause groin and pelvic pain. Imaging is heavily relied on to help diagnose these hernias; as such, correct interpretation of imaging studies can prevent delay in treatment for a patient with pain. We evaluated the accuracy and reliability of radiologic reports for detection of occult inguinal hernias in patients with groin and pelvic pain. STUDY DESIGN All CT and MRI studies ordered for groin or pelvic pain during a 5-year period were analyzed. Studies were included if the original radiologic reports were available for review, and if the patient underwent operative exploration. A blinded radiologist was asked to "over-read" the images. Operative findings were considered the gold standard with which radiologic reports were compared. RESULTS Of 322 CT and MRI studies, 125 groins met criteria. Original radiologic reports were 35% accurate, with 97% positive predictive value (PPV) and 13% negative predictive value (NPV). Over-read radiologist reports were significantly different (p < 0.0001), with 79% accuracy, 97% PPV, and 30% NPV. CONCLUSIONS Most radiologic reports issued for CT and MRI studies were incorrect for evaluation of occult inguinal hernia. Over-read radiologist reports were more than twice as accurate when evaluating the same images. The physician who is relying on radiologic reports to determine plan of care for a patient with groin or pelvic pain should inquire further into any negative study, especially if there is strong clinical suspicion for inguinal hernia.
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18
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Battey TWK, Dreizin D, Bodanapally UK, Wnorowski A, Issa G, Iacco A, Chiu W. A comparison of segmented abdominopelvic fluid volumes with conventional CT signs of abdominal compartment syndrome in a trauma population. Abdom Radiol (NY) 2019; 44:2648-2655. [PMID: 30953097 DOI: 10.1007/s00261-019-02000-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare the utility of abdominopelvic fluid volume measurements with established computed tomography signs for refractory post-traumatic abdominal compartment syndrome. METHODS This retrospective observational cohort study included 64 consecutive adult trauma patients with preoperative CT and diagnosis of refractory abdominal compartment syndrome requiring decompressive laparotomy at a level I trauma referral center between 2004 and 2014. We hypothesized that abdominal fluid volume measurements would be more predictive of the need for early laparotomy than previously described conventional CT signs of refractory ACS. Abdominopelvic fluid volumes were determined quantitatively using semi-automated segmentation software. The following conventional imaging parameters were recorded: abdominal anteroposterior:transverse ratio (round belly sign); infrahepatic vena cava diameter; distal abdominal aortic diameter; largest single small bowel wall diameter; hydronephrosis, inguinal herniation; and mesenteric and body wall edema. For outcome analysis, patients were stratified into two groups: those who underwent early (< 24 h) and late (≥ 24 h) decompressive laparotomy following CT. Correlation analysis, comparison of means, and multivariate logistic regression were performed. RESULTS Abdominal fluid volumes (p = 0.001) and anteroposterior:transverse ratio (p = 0.009) were increased and inferior vena cava diameter (p = 0.009) was decreased in the early decompressive laparotomy group. Multivariate analysis including conventional CT variables, fluid volumes, and laboratory values revealed abdominal fluid volumes (p = 0.012; Δ in log odds of 1.002/mL) as the only independent predictor of early decompressive laparotomy. CONCLUSIONS Segmented abdominopelvic free fluid volumes had greater predictive utility for decision to perform early decompressive laparotomy than previously described ACS-related CT signs in trauma patients who developed refractory abdominal compartment syndrome.
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19
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Abdulghaffar S, Almulla M, Gupta P, Mohamed AB. CT and Ultrasound findings in a case of De Garengeot's hernia: A case report. Radiol Case Rep 2019; 14:704-707. [PMID: 30976373 PMCID: PMC6441707 DOI: 10.1016/j.radcr.2019.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
Abstract
De Garengeot's hernia is a rare entity defined as the presence of the appendix within the femoral hernia sac. Although appendicitis is a common surgical emergency, appendix herniation into the groin results in a complex symptoms and signs, which make it difficult to diagnose clinically. We report a case of a 72-year-old male who had De Garengeot's hernia. Ultrasound and contrast-enhanced CT revealed a typical radiological feature of femoral hernia with the appendix herniating within femoral hernia sac. Surgical management of De Garengeot's hernia is controversial, and it is tailored according to the patient clinical situation and surgeon's preference. To the best of our knowledge, this is the first case that combines both CT and ultrasound findings with postoperative findings.
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20
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Botham SJ, Fillmore EP, Grant TS, Davies H, Hutchinson C, Tunstall R. Age-related changes in inguinal region anatomy from 0 to 19 years of age. Clin Anat 2019; 32:794-802. [PMID: 31066950 DOI: 10.1002/ca.23402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 11/10/2022]
Abstract
Knowledge of the age-related changes in inguinal region anatomy is essential in pediatric urological and abdominal surgery, yet little is published. This study aimed to determine the position of inguinal region structures and growth of the surrounding pelvis and inguinal ligament in subjects from 0 to 19 years of age. Anonymized contrast-enhanced CT DICOM datasets of 103 patients (63 male: 40 female) aged from 0 to 19 years had left and right sides analyzed by three independent observers. Exclusion criteria were applied. Growth of the pelvis and inguinal ligament were determined using fixed bony reference points. The position of the deep inguinal ring and femoral vasculature were determined as ratio of inguinal ligament length, measured from the anterior superior iliac spine. Growth of the pelvis in vertical and horizontal dimensions and of the inguinal ligament followed a positive polynomial relationship with increasing age, with no observed increase in growth rate during puberty. From 0 to 19 years, the deep inguinal ring moved superolaterally with respect to the inguinal ligament (from 0.74 to 0.60 of the distance along the inguinal ligament) and the femoral artery and vein moved medially (from 0.50 to 0.58, and 0.61 to 0.65 of the distance along the inguinal ligament, respectively). The position of the femoral artery, vein, and deep inguinal ring followed a logarithmic relationship with age. No significant left:right side or male:female differences were observed. From 0 to 19 years of age the femoral vasculature and deep inguinal ring change position as the pelvis grows around them. Clin. Anat. 32:794-802, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Sean J Botham
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Erin P Fillmore
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Thomas S Grant
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Harvey Davies
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Charles Hutchinson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Richard Tunstall
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
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21
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The lateral crescent sign. Abdom Radiol (NY) 2018; 43:3195-3196. [PMID: 29616286 DOI: 10.1007/s00261-018-1583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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22
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Kwee RM, Kwee TC. Ultrasonography in diagnosing clinically occult groin hernia: systematic review and meta-analysis. Eur Radiol 2018; 28:4550-4560. [DOI: 10.1007/s00330-018-5489-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022]
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23
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Cabarrus MC, Yeh BM, Phelps AS, Ou JJ, Behr SC. From Inguinal Hernias to Spermatic Cord Lipomas: Pearls, Pitfalls, and Mimics of Abdominal and Pelvic Hernias. Radiographics 2017; 37:2063-2082. [DOI: 10.1148/rg.2017170070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Miguel C. Cabarrus
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628 (M.C.C., B.M.Y., A.S.P., S.C.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (J.J.O.)
| | - Benjamin M. Yeh
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628 (M.C.C., B.M.Y., A.S.P., S.C.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (J.J.O.)
| | - Andrew S. Phelps
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628 (M.C.C., B.M.Y., A.S.P., S.C.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (J.J.O.)
| | - Jao J. Ou
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628 (M.C.C., B.M.Y., A.S.P., S.C.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (J.J.O.)
| | - Spencer C. Behr
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628 (M.C.C., B.M.Y., A.S.P., S.C.B.); and Department of Radiology, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (J.J.O.)
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Miyaki A, Yamaguchi K, Kishibe S, Ida A, Miyauchi T, Naritaka Y. Diagnosis of inguinal hernia by prone- vs. supine-position computed tomography. Hernia 2017; 21:705-713. [PMID: 28812202 DOI: 10.1007/s10029-017-1640-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 08/06/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to investigate the efficacy of prone-position computed tomography (CT) for detecting and classifying inguinal hernia relative to supine-position CT before laparoscopic inguinal hernia repair. METHODS Seventy-nine patients who underwent laparoscopic transabdominal preperitoneal repair of inguinal hernia were enrolled in this prospective study. Patients diagnosed with inguinal hernia by physical examination underwent abdominal CT in the supine and prone positions for preoperative assessment. The anatomy of the right and left inguinal regions was confirmed during the surgery and compared with the preoperative CT findings. RESULTS The 79 cases included 87 operated lesions and 71 non-operated contralateral inguinal sites. Of the 84 clinical hernias, inguinal hernia was detected significantly more frequently on prone-position CT images (84, 100%) than on supine-position CT images (55, 65.5%). In addition, the inguinal hernia type was determined with significantly greater accuracy on prone-position CT images (96.4%) than on supine-position CT images (58.3%). Twenty-two occult hernias were detected by laparoscopy. The detection rate and accuracy for determining the type of occult hernia were significantly greater when using prone-position CT images [19 of 22 lesions (86.4%) and 77.3%, respectively] than when using supine-position CT images [8 of 22 lesions (36.4%) and 27.3%, respectively]. CONCLUSIONS Prone-position CT is adequate for detecting and classifying inguinal hernia and for evaluating occult hernia.
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Affiliation(s)
- A Miyaki
- Department of Surgery, Nagareyama Central Hospital, 2-132-2 Higashihatsuishi, Nagareyama, Chiba, 270-0114, Japan.
| | - K Yamaguchi
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - S Kishibe
- Department of Surgery, Nagareyama Central Hospital, 2-132-2 Higashihatsuishi, Nagareyama, Chiba, 270-0114, Japan
| | - A Ida
- Department of Surgery, Nagareyama Central Hospital, 2-132-2 Higashihatsuishi, Nagareyama, Chiba, 270-0114, Japan
| | - T Miyauchi
- Department of Surgery, Nagareyama Central Hospital, 2-132-2 Higashihatsuishi, Nagareyama, Chiba, 270-0114, Japan
| | - Y Naritaka
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
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Goh IY, Sandstrom AL, Stapleton T, Aseervatham R, Grieve DA. The Duari hernia and recognition of the femoral vein compression sign. BMJ Case Rep 2017; 2017:bcr-2017-220141. [PMID: 28716872 DOI: 10.1136/bcr-2017-220141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Femoral hernias can be difficult to diagnose and are at high risk of strangulation. This report is of a rare case of an irreducible femoral hernia containing caecum and appendix presenting as an emergency. To the authors' knowledge, there have only been three cases reported, the first described by Duari. This case was incorrectly diagnosed preoperatively as an inguinal hernia, so the CT diagnosis of femoral hernias is reviewed, in particular demonstrating the radiological use of the femoral vein compression sign.
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Affiliation(s)
- Ian Y Goh
- Department of Surgery, Nambour Hospital, Nambour, Queensland, Australia
| | | | - Troy Stapleton
- Department of Radiology, Nambour Hospital, Nambour, Queensland, Australia
| | - Ratna Aseervatham
- Department of Surgery, Nambour Hospital, Nambour, Queensland, Australia
| | - David A Grieve
- Department of Surgery, Nambour Hospital, Nambour, Queensland, Australia
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26
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Contrera JD, Cardoso Sobrinho FT. Sliding inguinoscrotal hernia insinuating itself into the bladder, with calculi in the bladder and distal ureter. Radiol Bras 2017; 50:266-267. [PMID: 28894336 PMCID: PMC5586519 DOI: 10.1590/0100-3984.2015.0122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Chiang CC, Liu PH, Chou CP, Liu CH, Tsai MJ. Incarcerated Amyand's hernia. Tzu Chi Med J 2017; 29:129-130. [PMID: 28757782 PMCID: PMC5509206 DOI: 10.4103/tcmj.tcmj_27_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/30/2016] [Accepted: 10/18/2016] [Indexed: 06/07/2023] Open
Affiliation(s)
- Ching-Chung Chiang
- Department of General Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Pang-Hsu Liu
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chih-Pin Chou
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chung-Hsien Liu
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Department of Sports Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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28
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Al-Ramli W, Khodear Y, Aremu M, El-Sayed AB. A complicated case of amyand's hernia involving a perforated appendix and its management using minimally invasive laparoscopic surgery: A case report. Int J Surg Case Rep 2016; 29:215-218. [PMID: 27880929 PMCID: PMC5121154 DOI: 10.1016/j.ijscr.2016.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/26/2016] [Accepted: 11/07/2016] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Amyand's hernia is a rare condition of inguinal hernia in which the appendix is incarcerated within the hernia sac through the internal ring. Complications include acute appendicitis and perforated appendicitis, which are rare in incidence, accounting for about 0.1% of cases.1 These complications prove a diagnostic challenge due to their vague clinical presentation and atypical laboratory and radiological findings. Until recently, open appendectomy was the mainstay of treatment. Laparoscopic surgery offers a less invasive approach to confirming a diagnosis and serving as a therapeutic tool in equivocal cases. CASE PRESENTATION We report a case of a previously healthy 20-year-old male presenting with atypical signs and symptoms, as well as blood investigation results, and radiological findings of a perforated appendix within an Amyand's hernia. The patient was successfully managed using a minimally invasive laparoscopic appendectomy approach. DISCUSSION Until recently, open appendectomy was considered the mainstay in the management of complicated Amyand's hernia. Laparoscopic surgery provides a new avenue for dealing with diagnostic uncertainty with advantages including faster recovery time, reduced hospital stay, and better quality of life. CONCLUSION This case report highlights the concealing effects of an Amyand's hernia on a perforated appendix, the considerations required when an equivocal diagnosis present and the safe use of the minimally invasive laparoscopic surgery in the treatment of this rare condition.
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Affiliation(s)
- Wisam Al-Ramli
- Department of General Surgery, Letterkenny University Hospital, Ireland.
| | - Yahya Khodear
- Department of General Surgery, Letterkenny University Hospital, Ireland.
| | - Muyiwa Aremu
- Department of General Surgery, Letterkenny University Hospital, Ireland
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Tseng J, Poullos P. Factitious Disorder Presenting with Attempted Simulation of Fournier's Gangrene. J Radiol Case Rep 2016; 10:26-34. [PMID: 27761196 DOI: 10.3941/jrcr.v10i9.2774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Fournier's gangrene is a severe polymicrobial necrotizing fasciitis of the perineal, genital, or perianal regions. The classic presentation is severe pain and swelling with systemic signs. Crepitus and cutaneous necrosis are often seen. Characteristic CT findings include subcutaneous gas and inflammatory stranding. Unless treated aggressively, patients can rapidly become septic and die. Factitious Disorder is the falsification of one's own of medical or psychological signs and symptoms. Many deceptive methods have been described, from falsely reporting physical or psychological symptoms, to manipulating lab tests, or even injecting or ingesting foreign substances in order to induce illness. We present a case of a 35-year-old man with factitious disorder who attempted to simulate Fournier's gangrene by injecting his scrotum with air and fluid. We will review the clinical presentation and diagnosis of Factitious Disorder, as well as Fournier's gangrene.
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Affiliation(s)
- Joseph Tseng
- Department of Radiology, Stanford University, Palo Alto, USA
| | - Peter Poullos
- Department of Radiology, Stanford University, Palo Alto, USA
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Park HR, Park SB, Lee ES, Park HJ. Sonographic evaluation of inguinal lesions. Clin Imaging 2016; 40:949-55. [PMID: 27209238 DOI: 10.1016/j.clinimag.2016.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/24/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
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Lee RKL, Griffith JF, Ng WHA. High accuracy of ultrasound in diagnosing the presence and type of groin hernia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:538-547. [PMID: 25944106 DOI: 10.1002/jcu.22271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/07/2014] [Accepted: 02/28/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND To evaluate the accuracy of ultrasound (US) in diagnosing the the presence and type of groin hernia. METHODS We retrospectively studied the results of 172 US examinations of the groin in 151 patients (101 men and 50 women; mean age, 59 years) who had undergone US examination for suspected groin hernia. In total, 119 of the groin hernias had been diagnosed on US, and 108 (91%) had required subsequent surgery. All patients who had had positive results for hernia on US and did not undergo surgery (n = 11) and most of the patients whose US results had been negative for hernia (n = 48) underwent limited MRI or CT scanning. We determined the sensitivity, specificity, and accuracy of US in diagnosing the presence and type of groin hernia. To identify any change in the accuracy of US over time at our institution, we compared the sensitivity, specificity, and accuracy of its use from January 2002 through December 2010 (n = 54 groins) with those from January 2011 through December 2012 (n = 118 groins). RESULTS The overall rates of sensitivity and specificity of US for diagnosing the presence of groin hernia were 96% and 96%. These rates reflect improvements from 92% and 88% prior to 2011 to 98% and 100% beginning in 2011. In addition, the overall accuracy of US for diagnosing the type of groin hernia was 96%. This also improved over time at our center from 91% prior to 2011 to 98% beginning in 2011. CONCLUSIONS US is highly accurate at diagnosing the presence and type of groin hernia.
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Affiliation(s)
- Ryan Ka Lok Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Hong Kong
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Hong Kong
| | - Wing Hung Alex Ng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, The Chinese University of Hong Kong, Hong Kong
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Parker RA, Menias CO, Quazi R, Hara AK, Verma S, Shaaban A, Siegel CL, Radmanesh A, Sandrasegaran K. MR Imaging of the Penis and Scrotum. Radiographics 2015; 35:1033-50. [PMID: 26090569 DOI: 10.1148/rg.2015140161] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traditionally, due to its low cost, ready availability, and proved diagnostic accuracy, ultrasonography (US) has been the primary imaging modality for the evaluation of scrotal and, to a lesser extent, penile disease. However, US is limited by its relatively small useful field of view, operator dependence, and inability to provide much information on tissue characterization. Magnetic resonance (MR) imaging, with its excellent soft-tissue contrast and good spatial resolution, is increasingly being used as both a problem-solving tool in patients who have already undergone US and as a primary modality for the evaluation of suspected disease. Specifically, MR imaging can aid in differentiating between benign and malignant lesions seen at US, help define the extent of inflammatory processes or traumatic injuries, and play a vital role in locoregional staging of tumors. Consequently, it is becoming more important for radiologists to be familiar with the wide range of penile and scrotal disease entities and their MR imaging appearances. The authors review the basic anatomy of the penis and scrotum as seen at MR imaging and provide a basic protocol for penile and scrotal imaging, with emphasis on the advantages of MR imaging. Pathologic processes are organized into traumatic (including penile fracture and contusion), infectious or inflammatory (including Fournier gangrene and scrotal abscess), and neoplastic (including both benign and malignant scrotal and penile tumors) processes.
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Affiliation(s)
- Rex A Parker
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Christine O Menias
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Robin Quazi
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Amy K Hara
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Sadhna Verma
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Akram Shaaban
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Cary L Siegel
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Alireza Radmanesh
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Kumar Sandrasegaran
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
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Perforated Littre's hernia diagnosed on imaging: case report and review of literature. Jpn J Radiol 2015; 33:366-9. [PMID: 25895160 DOI: 10.1007/s11604-015-0422-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
We report the clinical details and imaging findings of a case of perforated Littre's hernia presenting as lower abdominal wall cellulitis in a 50-year-old male. Findings included herniation of an oral contrast opacified blind-ending pouch arising from the anti-mesenteric border of the distal ileum into the right inguinal canal, with extravasation of oral contrast. There were adjacent inflammatory changes with subcutaneous emphysema extending up to the right anterior chest wall. Meckel's diverticulum is rarely diagnosed preoperatively on imaging. We highlight the importance of computed tomography in imaging Meckel's diverticulum.
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Tirumani H, Vassa R, Fasih N, Ojili V. Small bowel obstruction in the emergency department: MDCT features of common and uncommon causes. Clin Imaging 2014; 38:580-8. [DOI: 10.1016/j.clinimag.2014.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/02/2014] [Accepted: 04/18/2014] [Indexed: 12/11/2022]
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Schurr E, Cytter-Kuint R, Ehrlichman M, Weiser G. Pediatric vasitis: A rare complication of epididymitis. Can Urol Assoc J 2014; 8:E436-8. [PMID: 25024800 DOI: 10.5489/cuaj.1892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Vasitis represents an inflammation of the vas deferens. This is a rare entity seen mostly in adult males following local surgery (e.g., vasectomy, hernia repair). Children with groin masses have a wide differential diagnosis. We describe a child with a groin mass following epididymitis diagnosed with vasitis and review the known literature regarding diagnostic tools and treatment. Vasitis in children, although rare, can be seen as a complication of epididymitis.
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Affiliation(s)
- Efrat Schurr
- Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ruth Cytter-Kuint
- Radiology Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Giora Weiser
- Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel
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Ivanschuk G, Cesmebasi A, Sorenson EP, Blaak C, Loukas M, Tubbs SR. Amyand's hernia: a review. Med Sci Monit 2014; 20:140-6. [PMID: 24473371 PMCID: PMC3915004 DOI: 10.12659/msm.889873] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Amyand’s hernia is defined as when the appendix is trapped within an inguinal hernia. While the incidence of this type of hernia is rare, the appendix may become incarcerated within Amyand’s hernia and lead to further complications such as strangulation and perforation. Incarceration of the appendix most commonly occurs within inguinal and femoral hernias, but may arise to a lesser extent in incisional and umbilical hernias. Incarcerated appendix has been reported in a variety of ventral abdominal and inguinal locations, yet its indistinct clinical presentation represents a diagnostic challenge. This paper reviews the literature on incarceration of the appendix within inguinal hernias and discusses current approaches to diagnosis and treatment of Amyand’s hernia and complications that may arise from incarceration of the appendix within the hernia.
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Affiliation(s)
- Galyna Ivanschuk
- Department of Anatomical Sciences, School of Medicine, St George's University, St. George, Grenada
| | - Alper Cesmebasi
- Department of Anatomical Sciences, School of Medicine, St George's University, St. George, Grenada
| | - Edward P Sorenson
- Department of Anatomical Sciences, School of Medicine, St George's University, St. George, Grenada
| | - Christa Blaak
- Department of Anatomical Sciences, School of Medicine, St George's University, St. George, Grenada
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St George's University, St. George, Grenada
| | - Shane R Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, USA
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A new accurate method of physical examination for differentiation of inguinal hernia types. Surg Endosc 2014; 28:1460-4. [PMID: 24399521 DOI: 10.1007/s00464-013-3359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is generally stated that preoperative differentiation between indirect and direct inguinal hernias by physical examination is inaccurate and irrelevant. With the expansion of the laparoscopic technique, new relevance has emerged. Laparoscopic correction of an indirect hernia is more challenging and time consuming than laparoscopic correction of a direct hernia. Preoperative knowledge concerning the type of hernia informs the laparoscopic surgeon about the required expertise and the expected operative time, and this knowledge is useful for training programs and management. The authors therefore developed a new accurate and easy method of physical examination to differentiate types of inguinal hernia. A prospective study was conducted to determine the accuracy of this new method that combines physical examination with a hand-held Doppler device (not ultrasound) to differentiate types of inguinal hernia. METHODS This prospective diagnostics study consisted of two consecutive parts. Each part included 100 consecutive patients presenting with an inguinal hernia. The inguinal occlusion test was used to differentiate the types of inguinal hernia during physical examination in the first part of the study. A hand-held Doppler device was used for adequate localization of the epigastric vessels in addition to the occlusion test in the second part of the study. Preoperative remarks were compared with findings during laparoscopic inguinal hernia repair. The McNemar symmetry χ (2) test was used for statistical evaluation RESULTS The first part of the study showed a preoperative accuracy of 35 % for direct inguinal hernias and 86 % for indirect inguinal hernias (p < 0.001). The second part of the study showed a preoperative accuracy of 79 % for direct inguinal hernias and 93 % for indirect inguinal hernias (p < 0.001) CONCLUSION: The inguinal occlusion test combined with the use of a handheld Doppler device is accurate in distinguishing direct and indirect inguinal hernias and provides useful management information in laparoscopic inguinal hernia repair.
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EAES Consensus Development Conference on endoscopic repair of groin hernias. Surg Endosc 2013; 27:3505-19. [PMID: 23708718 DOI: 10.1007/s00464-013-3001-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 04/23/2013] [Indexed: 02/07/2023]
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Trainer V, Leung C, Owen R, Venkatanarasimha N. External anterior abdominal wall and pelvic hernias with emphasis on the key diagnostic features on MDCT. Clin Radiol 2013; 68:388-96. [DOI: 10.1016/j.crad.2012.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/14/2012] [Accepted: 07/23/2012] [Indexed: 11/29/2022]
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Sodhi KS, Virmani V, Sandhu MS, Khandelwal N. Multi detector CT Imaging of Abdominal and Diaphragmatic Hernias: Pictorial Essay. Indian J Surg 2012; 77:104-10. [PMID: 26139963 DOI: 10.1007/s12262-012-0736-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022] Open
Abstract
Diagnosis of abdominal wall hernia is often a clinical problem, especially in occult or in obese patients. Multidetector CT is an accurate method of detecting various types of abdominal and diaphragmatic hernias. It clearly demonstrates the anatomical sites of hernial sac, its contents and possible complications.
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Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, 160 012 India
| | - Vivek Virmani
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, 160 012 India
| | - M S Sandhu
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, 160 012 India
| | - N Khandelwal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, 160 012 India
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Filippone A, Cianci R, Milano A, Pace E, Neri M, Cotroneo AR. Obscure and occult gastrointestinal bleeding: comparison of different imaging modalities. ACTA ACUST UNITED AC 2012; 37:41-52. [PMID: 21912990 DOI: 10.1007/s00261-011-9802-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patients with persistent, recurrent, or intermittent bleeding from the gastrointestinal (GI) tract for which no definite cause has been identified by initial esophagogastroduodenoscopy, colonoscopy, or conventional radiologic evaluation are considered to have an obscure GI bleeding (OGIB). The diagnosis and management of patients with OGIB is challenging, often requiring extensive and expensive workups. The main objective is the identification of the etiology and site of bleeding, which should be as rapidly accomplished as possible, in order to establish the most appropriate therapy. The introduction of capsule endoscopy and double balloon enteroscopy and the recent improvements in CT and MRI techniques have revolutionized the approach to patients with OGIB, allowing the visualization of the entire GI tract, particularly the small bowel, until now considered as the "dark continent" . In this article we review and compare the radiologic and endoscopic examinations currently used in occult and OGIB, focusing on diagnostic patterns, pitfalls, strengths, weaknesses, and value in patients' management.
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Affiliation(s)
- Antonella Filippone
- Department of Neurosciences and Imaging, Section of Radiological Imaging, "G. d'Annunzio" University, Chieti, Italy.
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