Investigations for hernia

Investigations for hernia

For most hernias, the diagnosis is made on clinical examina - tion. However, the patient may have symptoms suggesting a hernia but no hernia is found, or the patient may have a swelling suggestive of hernia but with clinical uncertainty . It is important to be certain that any symptoms described are due to a hernia and not to coexisting pathology , particularly when the major symptom is pain. Soft, reducible hernias are rarely painful. There may also be a requirement for more detailed information than can be found by examination alone. An ultra - sound scan may be helpful in cases of irreducible hernia when the di ff erential diagnosis includes a mass or fluid collection, enlarged lymph node or saphena varix or when the nature of the hernia content is in doubt. It is non-invasive, dynamic and low cost but highly operator dependent. Ultrasonog raphy may be useful in the early postoperative period to distinguish a haematoma or seroma from an early recurrence. - Computed tomography (CT) is helpful in complex ventral and incisional hernias, determining the number and size of muscle defects, identifying the content, giving some indication pathology such as ascites, occult malignancy and portal hyper tension. By showing the surrounding muscle layers CT helps planning abdominal wall reconstruction. Magnetic resonance imaging (MRI) can help in the diag nosis of sportsman’s (Gilmore’s) groin, w here pain is the pre senting feature and the surgeon needs to distinguish an occult hernia from an orthopaedic injury . Laparoscopy itself may be used. In incisional hernia, initial laparoscopy may determine w hether a laparoscopic approach is feasible or not. In inguinal hernia r epair by the transabdom inal route, initial laparoscopy can determine the presence of an occult contralateral hernia. However, laparoscopy will not identify intraparietal hernias such as lipomas of the spermatic cord and some epig astric and Spigelian hernias. Summary box 64.5 Investigations /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Plain radiograph – of little value Ultrasound scan – low cost, operator dependent CT scan – ventral and incisional hernia MRI – good in sportsman’s groin with pain Laparoscopy – useful to identify occult defects but not interstitial hernias