Diagnostic ultrasound ( PDFDrive )

472 PART II Abdominal and Pelvic Sonography
A
B
C
FIG. 13.2 Femoral Hernias Seen Only With Valsalva Maneuver. (A)
Abdominal computed tomography image shows no evidence of femoral
hernias. (B) Transverse ultrasound image of the femoral canal during
quiet respiration appears normal. (C) Transverse sonogram of the femoral
canal during Valsalva maneuver, showing bilateral fat-containing hernias,
with the right larger than the left (arrows).
A
B
FIG. 13.3 Indirect Inguinal Hernia. A 25-year-old man with right inguinal pain and a fat-containing indirect hernia. (A) Transverse sonogram
shows a hernia (calipers) in the right inguinal region. (B) Color Doppler image shows that the hernia (arrows) is lateral to the vessels. Only fat was
seen in the hernia sac. See also Video 13.1.
When a hernia has been described in the report, we also
report about our search for additional types of ipsilateral or
contralateral groin hernias. In a patient with an inguinal hernia,
presence of an ipsilateral femoral or spigelian hernia may necessitate
use of a larger piece of mesh. Presence of a contralateral
hernia may lead to bilateral rather than unilateral repair. Children
in particular are oten found to have bilateral inguinal hernias. 9
HERNIA CONTENTS
Hernias are composed of a sac, the parts of which are described
as the neck, the body and fundus, and the hernia contents. he
inguinal hernia sac consists of peritoneum, which protrudes
through the abdominal defect or “hernial oriice” and envelopes
the hernial contents. he neck of the sac is situated at the defect.
Hernias with a narrow or rigid neck are more likely to obstruct
and strangulate. he body is the widest part of the hernia sac,
and the fundus is the portion furthest away from the defect.
Viscera most likely to enter a hernia sac are those normally situated
in the region of the defect and those that are mobile—for
example, the omentum and small bowel.
Most sonographically detected hernias do not contain bowel.
In fact, most hernias contain only fat (Fig. 13.3, Video 13.1).
he origin of the fat may be intraperitoneal (mesenteric or
omental), preperitoneal, or, in rare instances, both (Video 13.2).
Hernias that contain intraperitoneal fat may contain bowel later
and thus may be a greater risk than those that contain only
preperitoneal fat. Some hernias contain free luid of intraperitoneal
origin (Fig. 13.4). Hernias that contain bowel are considered
higher risk because strangulation may lead to infarction of
bowel (Fig. 13.5, Video 13.3). Large hernias that are the most
likely to contain bowel are easier to detect clinically and less