Diagnostic ultrasound ( PDFDrive )

488 PART II Abdominal and Pelvic Sonography
rate and earlier recovery of full sports activity compared with
open surgery or conservative management. 40-42
ABDOMINAL WALL OR
VENTRAL HERNIAS
Ventral hernias are hernias through the anterior and lateral
abdominal wall (excluding inguinal hernias). Midline hernias
FIG. 13.35 Strangulated Spigelian Hernia. Transverse extended–
ield-of-view image shows strangulated left spigelian hernia containing
large bowel and fat (arrows). Note the hyperechoic texture of the
edematous strangulated contents.
include umbilical, paraumbilical, epigastric, and hypogastic.
Included in our discussion of abdominal wall hernias are incisional
hernias, although these of course can occur where any incision
has been made. Spigelian hernias are discussed earlier with
inguinal region hernias, but when located above the groin, they
are also considered in this group of ventral hernias. Ater adhesions,
abdominal wall hernias are the second leading cause of
small bowel obstruction and account for 10% to 15% of all small
bowel obstructions. 43,44 However, as these authors point out, the
presence of a hernia does not imply that it is the source of the
obstruction. To establish the hernia as the obstructing point,
one must make an efort to demonstrate the dilated loop leading
into the hernia sac and a collapsed loop exiting from the point. 44
hese hernias have increased in incidence over time, 45 perhaps
related to our aging population and comorbidities such as obesity.
Linea Alba Hernias
Linea alba hernias are anterior abdominal wall hernias that
protrude through the linea alba. hose that occur superior to
the umbilicus are called epigastric hernias, and those that occur
inferior to the umbilicus are called hypogastric hernias. Hypogastric
hernias are much less common than epigastric hernias
because the linea alba is much narrower and shorter inferior to
A
B
FIG. 13.36 Inguinal Wall Insuficiency Versus Direct Inguinal Hernia. Long-axis views show different appearance of posterior inguinal
wall insuficiency and direct inguinal hernia. (A) Insuficiency of the posterior inguinal wall (long arrows). Short arrow is inferior epigastric artery.
(B) Frank direct inguinal hernia extends distally within the inguinal canal in a ingerlike projection (long arrows) posterior to the spermatic cord. At
the level of the proximal inguinal canal, the distinction is possible only on long-axis views, because insuficiency and frank hernia appear identical
on short-axis views obtained proximally. Short arrow is inferior epigastric artery.