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Aims:Ultrasound is a non-invasive, non-ionising radiation modality which is highly successful at soft tissue imaging. Groin pain from an occult hernia can be a difficult clinical diagnosis made easier by good imaging. The aim of this study was to demonstrate the accuracy of ultrasound in diagnosing and typing the groin hernia, which could lead to its justification of use in the imaging of the occult hernia. Patients and Methods: A total of 118 patients with a clinical diagnosis of a groin hernia, prospectively underwent a blinded, ultrasound examination of the groin. All patients underwent surgery and these findings were compared with the ultrasound results. Results: 120 symptomatic groins in 118 patients underwent surgery. Ultrasound diagnosed 118 hernias and there were two normal ultrasound examinations. Surgery confirmed the same two patients to be normal -ultrasound sensitivity for all hernias was 100% with 100% specificity. Two femoral hernias were seen in this study, both correctly identified at ultrasound. Of the inguinal hernias, ultrasound identified 36 of 42 direct hernias (sensitivity 86%, specificity 97%) and 72 of 74 indirect hernias (sensitivity 97%, specificity 87%) Conclusions: This study confirms that ultrasound can accurately diagnose groin hernias and this may justify its use in the assessment of the occult hernia.

Four patients are reported in whom massive haemorrhage from severe hepatic trauma was managed initially by conservative surgery and packing. The patients were then transferred by ambulance to Addenbrooke's Hospital where further treatment involved elective surgery and removal of packs. All 4 patients were discharged from hospital and have made full recoveries. It is felt that the management of liver trauma should be to do the minimum that is necessary to staunch bleeding, by suture, arterial ligation, lobectomy, resectional debridement or simply by packing. This allows the patient's haemodynamic state to be restored to normal before further surgery is attempted.

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Ultrasound offered a diagnosis for the symptomology in 82 patients (70.6%) of which 59 were herniae. The positive predictive value for hernia is 98.3%. Twenty-six patients with no diagnosis or confirmation of herniae on follow-up showed symptom resolution in 22 cases, and four patients were treated by the pain clinic.