Diagnostic ultrasound ( PDFDrive )

CHAPTER 13 Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall 487
Skin
Anterior lamina
of the rectus sheath
Rectus m.
Fat
Ext. obliq. m.
Int. obliq. m.
Transv. abd. m.
Transversalis
fascia
Peritoneum
Posterior lamina
of the rectus sheath
Ext obliq
Int obliq
Transv abd
Rectus
FIG. 13.32 Spigelian Hernia: Torn Aponeuroses. Small, spigelian hernia in which the aponeuroses of both the transverse abdominis (TA) and
internal oblique (IO) muscles are torn, but in which the external oblique (EO) aponeurosis, as usual, is intact. This is the most common pattern of
aponeurosis defects in spigelian hernias.
FIG. 13.33 Spigelian Hernia: “Mushroom” Shape. Transverse
extended–ield-of-view sonogram shows small, nonreducible, fat-containing
right spigelian hernia. Because the external oblique aponeurosis is not
torn, it forces the hernia sac to extend medially over the anterior surface
of the right rectus muscle and laterally over the anterior aspect of the
right external oblique muscle. This results in a mushroom or anvil shape,
which correlates with nonreducibility and an increased risk of
strangulation.
Ultrasound can show tendinosis in the rectus and adductor
tendons in some cases (Fig. 13.38), but not as reliably as MRI,
which can also demonstrate osteitis pubis and indings such as
the secondary clet. In a patient with other pathology, only
repairing an inguinal hernia or posterior wall deiciency may
not cure the patient’s groin pain. hus optimal imaging workup
of athletes with groin pain usually requires both dynamic
ultrasound of the groin and MRI. 37,39 In patients with inguinal
FIG. 13.34 Spigelian Hernia: Typical Shape. Nonreducible left
spigelian hernia contains bowel and has a narrow neck and broad fundus,
the typical shape for spigelian hernias.
hernia or inguinal wall insuiciency, both surgical repair of the
hernia and surgical or medical treatment of the associated
tendinosis and pubic symphysis instability may be necessary.
Laparoscopic repair of sports hernia via either transabdominal
preperitoneal or extraperitoneal approach has a high success