Advertisement

Hernia

, Volume 16, Issue 3, pp 307–314 | Cite as

Computed tomography scan diagnosis of occult groin hernia

  • J. F. W. GarveyEmail author
Original Article

Abstract

Background

The value of computed tomography (CT) for the diagnosis of clinically occult (hidden) groin hernia was assessed in a series of patients presenting with undiagnosed groin pain.

Methods

A total of 158 consecutive patients presenting over a period of 5 years with undiagnosed groin pain or lower abdominal pain and negative or equivocal clinical findings were radiologically assessed with non-contrast CT. The decision to manage operatively or conservatively was then based on a combination of the clinical and CT findings. Outcomes were assessed at 10 years follow-up.

Results

The study cohort comprised 158 patients presenting with groin or lower abdominal pain and/or swelling, and was studied prospectively. Seven of these patients were re-investigated at a later date after developing new pain on either the ipsilateral or contralateral side, giving a total of 165 CT examinations. One-third of cases (54) had clinically occult groin hernias and most of the remaining cases had diagnoses that could be managed non-operatively. Of those who came to surgery, the pre-operative CT diagnosis of hernia had a positive predictive value (PPV) of 92% and a negative predictive value (NPV) of 96% (overall accuracy 94%). Lipoma of the spermatic cord was responsible for three of five false-positive CT results. The concept of sports hernia/groin disruption injury (GDI) was encountered, and this entity is discussed in this paper. In the group of patients without hernia findings on CT, the most common diagnoses were rectus abdominis and/or pyramidalis muscle injury which could be treated by physiotherapy (22%), GDI (16%), post-surgical problems (14%), miscellaneous (20%) and ‘no abnormality’ was identified in 15%. Overall, there were 111 patients with a ‘non-hernia’ CT diagnosis, of which urological, gynaecological, gastrointestinal and neuralgia contributed to the non-musculoskeletal diagnosis.

Conclusion

This prospective non-contrast CT study of patients with undiagnosed chronic groin pain detected the majority of occult hernias requiring surgical intervention. These results suggest that CT can be a useful adjunct to the evaluation of patients presenting with chronic undiagnosed groin pain, but that experienced clinical judgment remains a critical element in the diagnostic pathway.

Keywords

Inguinal hernia diagnosis CT scan Obscure groin pain Chronic groin pain Sports hernia 

Notes

Acknowledgements

Dr. Michael T.W. Houang of Castlereagh Imaging, Edgecliff, Sydney, for performing the CT scans. Dr. John Read of Castlereagh Imaging, St. Leonards, Sydney, for producing the CT radiographs, reviewing the manuscript and contributing to the discussion. Mrs. Tracey Garvey (B.Appl.Sci.) who managed the data analysis. Dr. James Caristo FRACS, Surgeon, for the surgical assistance. Mr. Reinhold (Ray) Muller, Senior Lecturer (Biostatistics and Epidemiology), School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, for the assistance in interpreting the findings and advice on quality measures. This research complies with the current laws of the Commonwealth of Australia.

Conflict of interest

There are no author disclosures.

References

  1. 1.
    Simons MP, Aufenacker T, Bay-Nielsen M et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403PubMedCrossRefGoogle Scholar
  2. 2.
    Højer AM, Rygaard H, Jess P (1997) CT in the diagnosis of abdominal wall hernias: a preliminary study. Eur Radiol 7(9):1416–1418PubMedCrossRefGoogle Scholar
  3. 3.
    Smedberg SG, Broomé AE, Elmér O et al (1985) Herniography in the diagnosis of obscure groin pain. Acta Chir Scand 151(8):663–667PubMedGoogle Scholar
  4. 4.
    Ekberg O (1981) Inguinal herniography in adults: technique, normal anatomy, and diagnostic criteria for hernias. Radiology 138:31–36PubMedGoogle Scholar
  5. 5.
    Orchard JW, Read JW, Neophyton J et al (1998) Groin pain associated with ultrasound finding of inguinal canal posterior wall deficiency in Australian Rules footballers. Br J Sports Med 32:134–139PubMedCrossRefGoogle Scholar
  6. 6.
    Omar IM, Zoga AC, Kavanagh EC et al (2008) Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics 28:1415–1438PubMedCrossRefGoogle Scholar
  7. 7.
    van den Berg JC, de Valois JC, Go PM et al (1999) Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings. Invest Radiol 34(12):739–743PubMedCrossRefGoogle Scholar
  8. 8.
    van Veen RN, de Baat P, Heijboer MP et al (2007) Successful endoscopic treatment of chronic groin pain in athletes. Surg Endosc 21(2):189–193PubMedCrossRefGoogle Scholar
  9. 9.
    Zarvan NP, Lee FT Jr, Yandow DR et al (1995) Abdominal hernias: CT findings. AJR Am J Roentgenol 164:1391–1395PubMedGoogle Scholar
  10. 10.
    Morales-Conde S (2009) Sportsman’s hernia: an entity to be defined, diagnosed and treated properly? Videosurg Miniinvasive Tech 4(1):32–41Google Scholar
  11. 11.
    Muschaweck U, Berger L (2010) Minimal Repair technique of sportsmen’s groin: an innovative open-suture repair to treat chronic inguinal pain. Hernia 14:27–33PubMedCrossRefGoogle Scholar
  12. 12.
    Young J, Gilbert AI, Graham MF (2007) The use of ultrasound in the diagnosis of abdominal wall hernias. Hernia 11:347–351PubMedCrossRefGoogle Scholar
  13. 13.
    Lilly MC, Arregui ME (2002) Lipomas of the cord and round ligament. Ann Surg 235(4):586–590PubMedCrossRefGoogle Scholar
  14. 14.
    Gilmore OJA (1992) Gilmore’s groin—ten years experience of groin disruption. Sports Med Soft Tissue Trauma 3:12–14Google Scholar
  15. 15.
    Garvey JFW, Read JW, Turner A (2010) Sportsman hernia: what can we do? Hernia 14:17–25PubMedCrossRefGoogle Scholar
  16. 16.
    Wollin M, Lovell G (2006) Osteitis pubis in four young football players: a case series demonstrating successful rehabilitation. Phys Ther Sport 7:153–160CrossRefGoogle Scholar
  17. 17.
    Meyers WC, McKechnie A, Philippon MJ et al (2008) Experience with “sports hernia” spanning two decades. Ann Surg 248(4):656–665PubMedGoogle Scholar
  18. 18.
    Aguirre DA, Santosa AC, Casola G et al (2005) Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi-detector row CT. Radiographics 25:1501–1520PubMedCrossRefGoogle Scholar
  19. 19.
    Miller PA, Mezwa DG, Feczko PJ et al (1995) Imaging of abdominal hernias. Radiographics 15:333–347PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Groin Pain ClinicSydneyAustralia

Personalised recommendations