Doppler and High Resolution Ultrasound in Assessment of Complicated Anterior Abdominal Wall Hernias

Abstract

Anterior abdominal wall hernias are common diseases of the abdomen. Their types include groin hernias, followed by femoral and umbilical. Complications of abdominal hernias include obstruction, strangulation and incarceration. An incarcerated abdominal wall hernia was usually associated with a sonographic appearance that clearly differed from the sonographic appearance of a non-incarcerated hernia. Aims: The aim of this study was to investigate with sonography whether distinct crosssectional imaging signs exist to differentiate incarcerated and non-incarcerated abdominal wall hernias Patients and Methods: This study included 30 cases, with suspected complicated anterior abdominal wall hernia, underwent ultrasound examination of the hernia as well as the abdomen with
the help of color Doppler ultrasound, to determine the sonographic signs of complicated hernias. Results: We found that the most important signs of incarcerated hernial strangulation, of which is the absence of color flow within the bowel wall. More supporting criteria suggesting incarceration are herniated bowel wall thickening (with cut off value of 3 mm), free fluid in the hernial sac which
suggests high incidence of complication, fluid within the herniated bowel loop, and dilated bowel loops in the abdomen which suggest high possibility of bowel obstruction. Conclusion: Ultrasound examination is extremely helpful as an easy bed side examination in case of suspected abdominal wall hernial complication, helping to diagnose a hernia, its contents and if complicated especially strangulation which needs immediate surgery to treat this life threatening condition.