Diagnostic ultrasound ( PDFDrive )

CHAPTER 13 Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall 493
A
B
C
FIG. 13.49 Infected Urachal Sinus in Patient With Umbilical
Pain and Discoloration. (A) Transverse view shows an edematous
umbilicus. (B) Longitudinal view shows a patent urachal sinus
tract (arrows) passing through the edematous tissues in the inferior
umbilicus. (C) Longitudinal view with color Doppler ultrasound
shows intense inlammatory hyperemia with the inlamed tissues
that surround the infected patent urachal sinus tract (arrow).
dynamic ultrasound versus CT in the assessment of suspected
incisional hernias, of 109 patients, 102 and 107 had incisional
hernia noted on CT and ultrasound, respectively. he measurements
of the hernias were similar comparing the techniques. 50
Repair of the hernia can be by either laparoscopic or open repair. 51
In a retrospective study of ventral wall hernias, the main indication
was pain in 78%, and 10% had an acute presentation with
incarceration or strangulation. 52 Mesh repair is being increasingly
performed because it seems to be associated with fewer
recurrences. 53
Multiple Hernias
Patients who have one type of hernia are more likely to have
additional hernias. hese patients are more likely to have contralateral
hernias of the same type, and they are more likely to have
either ipsilateral or contralateral hernias of diferent types. here
are several reasons for this. First, bilateralism may be caused
by timing of closure of fetal canals, and delayed closure for any
reason is likely to afect both sides simultaneously. Second,
underlying factors that lead to formation of hernias can afect
all sites simultaneously. Factors that increase the risk of hernias
include any cause of chronically increased intraabdominal pressure,
as well as repetitive stress. Pregnancies, morbid obesity,
and ascites can increase intraabdominal pressure long enough
to lead to development of hernias. Certain professions lead to
repetitive stress injuries. Sedentary lifestyle, nutritional deiciencies,
and hereditary factors can result in weak connective tissues.
In a patient with unilateral groin pain but no demonstrable
hernia on that side during dynamic ultrasound, the study can
be stopped ater examining the symptomatic side. However, in