Ultrasound in patients with equivocal inguinal hernia

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND | 2020. Objective: To determine the correlation of ultrasound (US) diagnosis and further management in patients with equivocal inguinal hernia. Materials and Methods: The Institutional Review Board approved the present retrospective study of US diagnosis and medical record in patients with equivocal inguinal hernia, who underwent US during a consecutive five-year period. The clinical indications and physical examinations were recorded, and the US diagnosis was evaluated. The correlation of the US diagnosis and further management (operative or non-operative management) was reviewed. Results: One hundred twenty-seven patients, with 143 sides, were included of which 48 of 143 (33.6%) had visualized inguinal hernia by US and 45 of these (93.8%) were planned for surgery. The rest, 95 of 143 (66.4%), showed various findings such as solid lesions in 11 of 95 (11.6%), cystic lesions in 8 (8.4%), lymph nodes in 6 (6.3%), other findings in 22 (23.2%), and normal findings in 48 (50.5%). At step of treatment planning, 45 of 48 (93.8%) of patients with and 20 of 95 (21.1%) of those without visualized hernia were planned for surgery (p<0.001). At step of surgery, 30 of 48 (62.5%) of patients with and 22 of 95 (23.2%) of those without visualized hernia underwent surgery (p<0.001). At step of final diagnosis, the inguinal hernia was diagnosed in 30 of 32 (93.8%) and 8 of 84 (9.5%) in the groups with and without visualized inguinal hernia by US (p<0.001). US has sensitivity of 78.9%, specificity of 97.4%, accuracy of 91.4%, PPV of 93.8%, and NPV of 90.5% in patients with equivocal inguinal hernia. Conclusion: US has an obvious role in diagnosis and guiding further management of patients with clinically equivocal inguinal hernia.