Abdominal wall hernias: review of herniography and correlation with cross-sectional imaging.

Abstract

Herniography is an accurate means of identifying groin hernias when the clinical diagnosis is uncertain. Its role in evaluation of other types of ventral hernias is less clear; however, with minor modifications in technique, herniography is also useful in these cases. This article reviews the technique of herniography, normal variations in anatomy, and interpretation of herniograms of the groin and anterior abdominal wall on the basis of 72 patients studied over 3 1/2 years. Herniography is also compared with cross-sectional imaging techniques. Inguinal and femoral hernias are best shown and classified with herniography. Ventral hernias are well demonstrated by both herniography and cross-sectional imaging; however, herniation of only fat and supine imaging may lead to misdiagnosis with computed tomography or ultrasound. Spigelian hernias are probably best depicted with cross-sectional imaging. Diagnostic pitfalls of herniography are reviewed, including the need for obtaining postexercise radiographs, oblique radiographs, and tangential radiographs.

Hernias of the greater omentum through the antero-superior abdominal wall: an extensive pictorial MDCT review with emphasis on typical anatomic landmarks. A pictorial essay

“…There are two types of DIHs: one extends inferiorly from the medial umbilical fossa (Figs. 20 & 21) and the other extends inferiorly from the supravesical fossa (38). It is not uncommon to find synchronous DIHs and IIHs in a patient, either unilaterally or contralaterally.…”

“…The clinical symptoms are undistinguishable from those of IIHs and groin pain is the primary symptom. Unlike IIHs incarceration is uncommon in DIH because they are characterized by a broad neck (38). They occur medial to the lateral umbilical fold.…”

“…IHs are iatrogenic and occur in a weak area in the abdominal wall after abdominal surgery (27,38). Infection of the wound or obesity are major etiologic factors.…”

“…IH is at risk of irreducibility or incarceration, which (24). Congenital hernias are usually IIHs -protrusion through a patent processus vaginalis -and the hernia toneal fossa rather than extending directly inferiorly like DIHs (38). In addition, the neck of the hernia tends to be narrow as it passes through the internal inguinal ring.…”

“…They are unusual in women. They occur as a generalized bulge through an area of potential content includes bowel loops, omental fat or peritoneal fluid (24,38,45). Fluid may become encysted.…”