The role of ultrasound in the management of patients with occult groin hernias

• Published in: International journal of surgery (London, England) Vol. 12; no. 9; pp. 918 - 922
• Main Authors: Alabraba, E, Psarelli, E, Meakin, K, Quinn, M, Leung, M, Hartley, M, Howes, N
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-01-2014
• Subjects: Adult; Aged; Aged, 80 and over; Female; Groin; Groin hernia; Hernia, Inguinal - complications; Hernia, Inguinal - diagnostic imaging; Hernia, Inguinal - surgery; Herniorrhaphy; Humans; Male; Middle Aged; Occult; Patient Selection; Pelvic Pain - diagnostic imaging; Pelvic Pain - etiology; Predictive Value of Tests; Retrospective Studies; Surgery; Treatment Outcome; Ultrasonography; Ultrasound; Young Adult; Ultrasound; Occult; Groin hernia
• DOI: 10.1016/j.ijsu.2014.07.266
• EISSN: 1743-9159
• ISSN: 1743-9191

Abstract Introduction : Groin ultrasound scanning is commonly used to examine patients with obscure groin pain or swelling. A recent study has shown ultrasound has a poor positive predictive value (PPV) in diagnosing groin hernias although earlier studies reported PPV values as high as 100%. Our aims were to calculate ultrasound's accuracy in diagnosing occult groin hernias in symptomatic patients and assess how management of these patients is affected by ultrasound result. Methods : We retrospectively analysed 375 symptomatic adult patients, who between February 2008 and March 2010, had ultrasound to diagnose groin hernias when clinical examination was inconclusive. Patients were identified on a prospective radiology database and all groin ultrasounds were performed by either one consultant radiologist or one radiographer. Results : Ultrasound was positive in 199 patients, of which 118 underwent surgery. Using operative findings as the gold standard, ultrasound's PPV for groin hernias was 70% (95% CI: 62–78%). Ultrasound was equivocal in 42 patients of which hernias were diagnosed in 7 of the 10 who had surgery. Ultrasound was negative in 151 patients of which none were later diagnosed with hernias during 3 years' median follow-up. Conclusion : Ultrasound is poor in diagnosing occult groin hernias with a PPV of 70% suggesting a 30% chance of negative groin exploration. The equivocal ultrasound group requires careful follow-up as a considerable number were later diagnosed with hernia. The absence of subsequent hernia diagnosis in the negative ultrasound group suggests it may be a useful rule-out test to exclude occult groin hernias in symptomatic patients.