成人腹股沟区疝的CT诊断

目的评价多排螺旋CT（MDCT）在腹股沟区疝诊断中的价值。方法回顾性分析2009年612月96例经临床证实为腹股沟区疝患者的CT图像资料。通过多平面重建技术获得冠状位及矢状位图像,评价不同平面图像在腹股沟区疝诊断及分类中的应用价值。结果 63例斜疝患者（66疝）疝囊于腹壁下动脉外侧经腹股沟深环进入腹股沟管,疝囊位于精索或圆韧带前侧（43/66,65.2%）或前内侧（15/66,22.7%）;30例直疝患者（37疝）疝囊位于腹壁下动脉内侧,位于精索内侧（27/37,73.0%）;斜疝及直疝疝囊均走行于腹股沟韧带前上方;3例股疝患者（3疝）疝囊位于腹股沟韧带后下方,冠状位＂影像学股三角＂内。结论 MDCT对腹股沟区疝的诊断与鉴别诊断具有重要价值,可为手术前评估及手术中操作提供重要参考信息。     

Groin hernias in adults: value of color Doppler sonography in their classification.

PURPOSE: We assessed the abilities of color Doppler and power Doppler sonography to distinguish among types of groin hernias by demonstrating the inferior epigastric artery (IEA) and its relationship with the hernia sac. METHODS: Nineteen consecutive patients (14 men and 5 women), clinically diagnosed as having groin hernias and scheduled to undergo herniorrhaphy, were prospectively enrolled in this study. Ultrasound examinations were performed preoperatively with a 6-12-MHz linear-array transducer. The IEA was identified, if possible, and its relationship to the hernia sac assessed. The sonographic diagnoses were compared with the operative findings. RESULTS: There were 15 indirect inguinal hernias, 4 direct inguinal hernias, and 1 femoral hernia; 1 patient had bilateral inguinal hernias (indirect and direct). In 18 (90%) of 20 hernia cases, the trunk segment of the IEA could be visualized. In 11 (55%) of 20 hernia cases, the origin segment of the IEA could be visualized and its relationship with the hernia sac assessed. In 9 (82%) of the 11 hernia cases, hernia types were correctly diagnosed by sonography. The overall accuracy of sonography for diagnosing the type of hernia was 45% (9 of 20 hernias). CONCLUSIONS: Color Doppler sonography can accurately differentiate types of groin hernias if the origin segment of the IEA and the hernia sac can be visualized simultaneously. However, color Doppler sonography sometimes failed to visualize this segment.     

The pubic tubercle: a CT landmark in groin hernia

The aim of our study is to investigate the pubic tubercle as a reliable CT landmark in distinguishing the three types of groin hernia. CT scans of 42 patients with surgically confirmed groin hernia were reviewed. For each patient, both the anatomical structure within the hernia and the state of the hernia to the inferior epigastric artery were specifically recorded. Hernias were also located within a schematic construction of orthogonal lines focused on the pubic tubercle. In this construction, inguinal hernias were ventral to the X-axis while femoral hernias were dorsal to the X-axis. Among the inguinal hernias, direct inguinal hernias were located strictly lateral to the Y-axis while indirect inguinal hernias medially crossed the Y-axis. All these CT results were compared to the surgical findings. The inferior epigastric artery was visualized in 90% patients and, in these cases, the situation of the hernia to the artery on CT showed no discordance with surgical findings. Within the schematic construction of orthogonal lines focused on the pubic tubercle, 50% were considered as indirect inguinal hernias, 31% as direct inguinal hernias and 19% as femoral hernias. For each patient, the CT diagnosis was consistent with the surgical report.     

Indirect inguinal hernia containing portosystemic shunt vessel: A case report

BACKGROUNDInguinal hernia repair is one of the most common general surgical operations worldwide. We present a case of indirect inguinal hernia containing an expanded portosystemic shunt vessel.CASE SUMMARYWe report a 72-year-old man who had a 4 cm × 4 cm swelling in the right inguinal region, which disappeared with light manual pressure. Abdominal-pelvic computed tomography (CT) revealed a right inguinal hernia containing an expanded portosystemic shunt vessel, which had been noted for 7 years due to liver cirrhosis. We performed Lichtenstein’s herniorrhaphy and identified the hernia sac as being indirect and the shunt vessel existing in the extraperitoneal cavity through the internal inguinal ring. Then, we found two short branches between the expanded shunt vessel and testicular vein in the middle part of the inguinal canal and cut these branches to allow the shunt vessel to return to the extraperitoneal cavity of the abdomen. The hernia sac was returned as well. We encountered no intraoperative complications. After discharge, groin seroma requiring puncture at the outpatient clinic was observed.CONCLUSIONIf an inguinal hernia patient has portal hypertension, ultrasound should be used to determine the contents of the hernia. When atypical vessels are visualized, they may be shunt vessels and additional CT is recommended to ensure the selection of an adequate approach for safe hernia repair.     

Acute appendicitis in a femoral hernia: an unusual presentation of a groin mass

Although most groin masses are simple hernias, occasionally these hernias contain more than just small intestine. Femoral hernias, which are less common than inguinal, are more often found in females. Stomach, omentum, colon, or an appendix each has been reported to be contained in a femoral hernia. Having an acutely inflamed appendix contained in a femoral hernia sac in a male is extraordinarily rare. We report a case of acute appendicitis contained in a femoral hernia of a 76 year old man. This entity presents much like an incarcerated hernia, and differentiating the two can lead to changes in the surgical management.     

经内环入路放置Kugel补片治疗腹股沟疝

目的介绍一种新的手术入路放置Kugel补片治疗腹股沟疝。方法将原始术式经内环上方腹横筋膜切口进入腹膜前间隙进行疝囊处理和放置补片的手术入路，改成经内环口进入腹膜前间隙进行疝囊处理和放置Kugel补片治疗腹股沟疝。结果103例病例术后无复发，亦未见明显并发症。结论Kugel修补术治疗腹股沟疝集中了开放手术和腔镜手术的优点，经内环入路放置Kugel补片使操作更为安全和简便，值得推广。     

Color duplex sonography: diagnostic tool in the differentiation of inguinal hernias.

We investigated the accuracy of combined physical and color duplex sonographic examination in the preoperative distinction of direct inguinal hernias. After a learning period (with 15 male patients) 50 consecutive male patients who underwent surgery in our department for small inguinal hernias between July 1995 and April 1996 were examined. On color duplex examination the relationship between the hernial sac and the inferior epigastric artery was determined. Intraoperative results were then compared with the data obtained preoperatively. The sensitivity of our physical examination for direct inguinal hernia was 75% with a specificity and a positive predictive value of 100% and a negative predictive value of 80%. The identification of the IEA as well as the hernial sac was successful on every color duplex sonographic study. The sensitivity of color duplex sonography for direct inguinal hernias amounted to 90%, the specificity was 86%, the positive predictive value was 78%, and the negative predictive value was 89%. Both combined hernias found intraoperatively had not been detected either by physical examination or by color duplex examination. Correspondence of results obtained by physical examination and color duplex examination leads to high accuracy in the diagnosis of direct inguinal hernias.     

De Garengeot hernia with avascular necrosis of the appendix: A case report

BACKGROUNDAn incarcerated hernia is a common cause of acute abdominal pain. There are various types of incarcerated hernias, including incarcerated hernias of the appendix. These hernias are often complicated by appendiceal inflammation, necrosis, and suppuration, which affect the outcome of surgical repair. A De Garengeot hernia is a femoral hernia that contains the appendix. This type of hernia has a low incidence. When a De Garengeot hernia is clinically suspected, emergency surgical treatment should be performed as soon as possible.CASE SUMMARYA 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier. Physical examination revealed a 4 cm × 2 cm palpable mass in the right groin. The mass was hard and could not be reduced due to tenderness. It did not descend into the scrotum. B-ultrasound revealed an incarcerated hernia. During surgery, the hernia was found to contain the appendix, which exhibited distal avascular necrosis. A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia. Laparoscopic reduction of the incarcerated hernia, appendectomy, and small-incision femoral hernia repair were performed in the emergency department, and cefuroxime was administered as anti-infection therapy for 2 d postoperatively. After treatment, the patient had no abdominal pain or infection and was discharged on postoperative day 4. He had no recurrence of the inguinal hernia after 16 months of follow-up.CONCLUSIONDe Garengeot hernias have a low incidence and are difficult to diagnose. Laparoscopy is useful for their diagnosis and treatment.     

Meta‐analysis of Sonography in the Diagnosis of Inguinal Hernias

Groin hernias are common conditions, and there is a need for accurate imaging when the clinical diagnosis is not clear. A meta‐analysis was undertaken to investigate the diagnostic accuracy of sonography in the diagnosis of inguinal hernias. After review of literature searches, 9 original articles were included. Data were pooled and statistically analyzed. In the studies included, sensitivity ranged from 92.7% to 100%; specificity ranged from 22.2% to 100%; the positive predictive value ranged from 83.3 to 100%; and the negative predictive value ranged from 40 to 100%. Sonography has overall sensitivity of 96.6 %, specificity of 84.8%, and a positive predictive value of 92.6%. In cases of diagnostic uncertainty, sonography offers value as an initial imaging modality. It has advantages over other radiologic methods, as it is inexpensive and has minimal complications. When the clinical diagnosis of an inguinal hernia is uncertain, sonographic findings should be interpreted in conjunction with clinical judgment, as its diagnostic accuracy is reduced in the absence of any clinically palpable hernia.     

Single‐incision laparoscopic totally extraperitoneal repair for bilateral inguinal hernias after femoral‐femoral artery bypass in a patient on antiplatelet therapy: A case report

A 77‐year‐old man visited our hospital due to bilateral painful inguinal swellings. He had a history of femoral‐femoral artery bypass surgery for peripheral artery disease and took ethyl icosapentate. Additionally, he had a previous history of open left colectomy for descending colon cancer and had a median incision reaching the lower abdomen. With a diagnosis of bilateral direct inguinal hernias after femoral‐femoral artery bypass surgery, he underwent single‐incision laparoscopic surgery for totally extraperitoneal repair, continuing on ethyl icosapentate. During surgery, the preperitoneal space was safely and easily dissected, avoiding a subcutaneous vascular graft. No perioperative complications or hernia recurrence have been observed at 3 months follow‐up.     

超声隐匿性腹股沟疝诊断中影像学特点分析及应用

目的:探讨隐匿性腹股沟疝诊断中超声应用的影像学特点及应用效率分析.方法:纳入本院2019年5月—2020年5月收治的隐匿性腹股沟疝患者79例作为研究对象,分别对其进行超声以及多螺旋CT检查,鉴别诊断其疝内容物,并与患者最终的手术结果对照分析.结果:参与研究的79例患者中,腹股沟斜疝65例,占比82.28％;腹股沟直疝8...     

腹股沟疝的CT诊断价值探讨

目的 探讨腹股沟疝的CT表现及诊断价值。方法对21例腹股沟疝患者进行盆腔CT扫描检查，并进行分析。结果CT扫描检查能清楚地发现典型和不典型的腹股沟疝，显示疝囊、疝内容物及腹壁缺损程度。结论CT扫描检查对腹股沟疝，特别是不典型的腹股沟疝有一定的临床价值。     

Laparoscopic identification of combined pediatric femoral hernia and ruptured abdominal cyst of the canal of Nuck: A report of an extremely rare case

A 7-year-old girl was referred to our hospital with a suspected right-sided indirect inguinal hernia. An egg-sized elastic, non-painful mass was palpated in the right inguinal region. Preoperative CT demonstrated a 30-mm simple cystic mass in the right internal inguinal canal, which we diagnosed as an abdominal cyst of the canal of Nuck. Laparoscopy revealed that the abdominal cystic component was ruptured, so we performed Pott's procedure. However, the patient's right groin swelled on postoperative day 3, necessitating re-operation. The patient's symptoms recurred again after 3 months, despite having had two surgical repairs. In the third operation, a right-sided femoral hernia was confirmed and repaired via external and laparoscopic approaches. To the best of our knowledge, there have been no reports on the combination of femoral hernia and cyst of the canal of Nuck in children. A laparoscopic approach was useful for obtaining a definitive diagnosis and conducting a safe and secure surgical repair.     

Abdominal wall hernia mesh repair: sonography of mesh and common complications.

OBJECTIVE: The purposes of this study were (1) to review the sonographic in vitro and in vivo appearances of mesh for surgical repair of abdominal wall hernias, (2) to describe sonographic techniques and discuss the limitations of sonography in evaluation of mesh hernia repair, and (3) to illustrate common complications after mesh repair shown with sonography. METHODS: We identified interesting cases from the musculoskeletal sonographic database as well as from the teaching files of the authors, with surgical or other cross-sectional imaging corroboration. RESULTS: A compilation of the sonographic appearances of mesh used for anterior abdominal wall and inguinal hernia repair and complications diagnosable by sonography is presented. CONCLUSIONS: Sonography can be effective for evaluation of mesh and complications after mesh repair of anterior abdominal wall and inguinal hernias.     

Ultrasound diagnosis of acute appendicitis complicating De Garengeot’s hernia

De Garengeot’s hernia is a rare condition defined by the herniation of the vermiform appendix within a femoral hernia sac. We report a case of an 80-year-old woman admitted to our emergency department complaining of pain in the right groin. This symptomatology, present for 2 days, increased in the following 12 h. Ultrasonography (US) and contrast-enhanced computed tomography (CECT) were performed, which showed the herniation of the vermiform appendix in the femoral hernia sac. Doppler ultrasonography (DUS) and CECT were the fundamental imaging investigations for this diagnosis. The management of De Garengeot’s hernia is surgical through herniorrhaphy, which makes it possible to repair the femoral hernia and perform an appendicectomy in case of appendicitis.     

超声对腹股沟疝的鉴别分型诊断与其病因学关系的研究

目的 探讨超声检查在腹股沟疝鉴别分型诊断中的价值,为临床选择最佳手术方式提供重要参考.方法 对176例临床可疑腹股沟疝患者进行超声检查,记录腹股沟区包块的声像特征、血供、血液运行情况,以及与周围组织、血管的位置关系等,并与手术结果进行对照分析.结果 经超声诊断腹股沟疝的176例患者中,与手术结果相符者173例,超声诊断符合率达98.3%.其中斜疝146例,疝门直径〈3 cm,疝内容物经内环、腹股沟管及皮下环至阴囊局部形成异常团状回声,可见局部腹壁变化,疝囊位于精索静脉前方,内侧可见腹壁下动静脉血流伴行,腹压增大时,疝内容物可见肠壁增厚,层次结构模糊;直疝27例,疝门直径〉4 cm,疝内容物经直疝三角右后向前不进入阴囊,仅于腹股沟区形成异常回声区,局部腹壁无明显改变,疝囊位于精索静脉内后方,疝囊外侧可见腹壁下动静脉血流束伴行,腹压增大时,疝内容物可见肠壁略变薄,层次结构尚清晰.结论 超声可根据疝门大小、腹压变化前后局部腹壁厚度、疝内容物及疝囊与腹壁下动脉位置关系等情况的观察,直观地鉴别斜疝与直疝,是术前诊断及鉴别腹股沟疝分型的首选影像学方法.     

Amyand hernia: a case of an unusual inguinal herniace

Amyand hernia, named for the first person to describe an inguinal hernia containing the vermiform appendix, is an uncommon variant of an inguinal hernia. Presence of the appendix in the sac complicates the management of inguinal hernias. The appendix may be more prone to rupture when contained within a hernia sac, and herniation of an inflamed appendix into the scrotum can mimic an acute scrotum. A 50-year-old man presented with right lower quadrant abdominal pain associated with chills and anorexia. Physical examination revealed right lower quadrant tenderness and a right inguinal mass without associated skin changes. Laboratories were normal. A plain abdominal computed tomography scan for acute appendicitis showed an indirect right inguinal hernia with the appendix contained within the sac, which was incarcerated. Surgical consultation was obtained. The patient taken to the operating room, and his appendix was removed. The hernia was coincidentally repaired, and the patient was discharged soon thereafter. In cases suggestive of acute appendicitis complicating an inguinal hernia, the diagnosis of this unusual variant must be considered.     

Scar endometriosis manifested as a recurrent inguinal hernia

A 24-year-old woman was initially found to have a right inguinal hernia that occurred suddenly after heavy lifting. A right direct inguinal hernia was found during the initial operative procedure. The round ligament was excised, the internal ring was closed, and the hernia was repaired with mesh placed on the floor of the inguinal canal. Four months after an uneventful postoperative recovery, the patient returned with pain in the right inguinal area. Over the next 2 months, a deep painful bulge developed. Inguinal exploration revealed an endometrioma rather than recurrent inguinal hernia. A portion of the original hernia incision included part of a previous Pfannenstiel incision made 3 years previously for a cesarean section. Scar endometriosis most probably occurred from peritoneal seeding from the Pfannenstiel incision and mimicked the findings of a recurrent inguinal hernia.     

Pediatric hernias

Indirect inguinal hernias, hydroceles, and umbilical hernias are extremely common in infancy and childhood. Less commonly encountered are femoral, direct inguinal, epigastric, and Spigelian hernias. Patient history and physical examination are usually sufficient for the diagnosis of a hernia. If the diagnosis is uncertain, ultrasound examination or herniograms are occasionally employed. Magnetic resonance imaging may be useful in diagnosing abdominal wall hernias in obese patients for whom physical examination is difficult.