Diagnostic ultrasound ( PDFDrive )

CHAPTER 13 Dynamic Ultrasound of Hernias of the Groin and Anterior Abdominal Wall 497
A
B
D
C
FIG. 13.55 Mesh After Hernia Repair. (A) Normal mesh. The mesh used in this hernia repair is thick and echogenic, and individual ibers
within the mesh are visible. It casts a strong acoustic shadow. The mesh can be well seen in only a small percentage of cases. (B) Herniorrhaphy
mesh with strong shadow. Mesh typically appears thick and echogenic and casts a strong acoustic shadow, but individual ibers within the mesh
(m) are not visible sonographically. (C) Herniorrhaphy mesh with weak shadow. Thin, poorly deined mesh casts only a weak acoustic shadow.
Such mesh can be identiied only with high-frequency transducers, optimal technique, and careful search. (D) Wrinkled herniorrhaphy mesh.
Mesh can bulge during the Valsalva maneuver or when the patient is scanned in the upright position; this may be normal. These split-screen images
show wrinkled mesh in the supine position in quiet respiration (left image) and bulging with straightening of some of the wrinkles in the upright
position (right image).
preperitoneal fat may not be emergencies. It is the presence of
bowel loops within strangulated hernias that makes them
emergent. Instead of incarcerated, we use the term nonreducible
because the referring clinician is less likely to confuse it with
strangulation.
he shape of hernias afects their reducibility and their likelihood
of becoming obstructed or strangulated in the future. he
hernia type afects its shape. Hernias that have relatively broad
necks in comparison to their fundi are usually completely reducible
and rarely become obstructed or strangulated. Groin hernias
that typically have broad necks and infrequently strangulate are
direct inguinal hernias and some indirect inguinal hernias.
Hernias that have relatively narrow necks in comparison to their
fundi are more likely to be nonreducible, to become obstructed,
and to strangulate. Hernia types that typically have narrow necks
and are at high risk for strangulation include femoral (Video
13.23), spigelian (see Figs. 13.33 and 13.35), linea alba (see Fig.
13.45; Fig. 13.59), umbilical, and some indirect inguinal hernias.
Although vascular compromise is the hallmark of strangulation,
Doppler ultrasound is not the most sensitive modality for