Asymptomatic contralateral inguinal and ventral hernias among people with a workers’ compensation claim for hernia

• Published in: Journal of visceral surgery Vol. 159; no. 6; pp. 458 - 462
• Main Authors: Crijns, T.J., Fatehi, A., Coopwood, B., Ring, D., Tonn, M.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-12-2022
• Subjects: Abdominal hernia; Adult; Contralateral; CT scan; Groin - surgery; Hernia, Inguinal - complications; Hernia, Inguinal - diagnostic imaging; Hernia, Ventral - diagnostic imaging; Hernia, Ventral - etiology; Humans; Incidental findings; Retrospective Studies; Workers' Compensation; Workers’ Compensation insurance; Workers’ Compensation insurance; Abdominal hernia; Contralateral; CT scan; Incidental findings
• ISSN: 1878-7886; 1878-7886
• DOI: 10.1016/j.jviscsurg.2021.09.008

•A notable proportion of people (35 out of 106, 33%) with a Workers’ Compensation claim for hernia have an incidental (asymptomatic) hernia elsewhere.•People who have a second, incidental hernia, are either less likely to be offered or less likely to choose surgery.•Our data support that hernia might be incidental to abdominal symptoms (e.g. muscle strain) but is unlikely to be caused by strenuous physical activity.•Population-based studies of the prevalence of incidental hernia by occupation and longitudinal studies of people starting heavy labor occupations can help determine if there is an association between heavy work and pathology of abdominal hernia.
There is a gap in evidence that demonstrates an increased risk of hernia formation in laborers. A notable incidence of a second asymptomatic hernia among people making a workers’ compensation claim for a hernia would suggest that the pathology is not acute and probably not related to work, or the performance of a single strenuous event.
We performed a retrospective database study of a consecutive sample of 106 adults who claimed a work-related abdominal hernia between September 2016 and December 2018 and had a Computed Tomography (CT) scan as part of a diagnostic workup. Hernias were classified as incidental if patients had a contralateral inguinal hernia with unilateral groin symptoms, or if patients had a ventral hernia with only groin symptoms or vice versa.
Thirty-three percent of patients had an incidental hernia. No patient factors were associated with having an incidental hernia. Higher BMI and having a concurrent incidental hernia were associated with lower odds of surgical treatment under the injury claim.
Abdominal symptoms after a work event might lead to a diagnosis of hernia, and there is a notable likelihood that the hernia is incidental and unrelated to work. New symptoms at or near the site of an abdominal hernia may or may not be from the hernia, and very often are more consistent with an abdominal muscle strain. The clinical or imaging finding of an abdominal wall defect or the presence of a hernia may be incidental, unrelated to the physical activity.