From the Guidelines
To diagnose an incisional hernia, a thorough physical examination and medical history are essential, supplemented by imaging studies such as ultrasound or CT scans as needed. The diagnosis of an incisional hernia typically begins with a physical examination of the site of a previous surgical incision, looking for a visible bulge or protrusion, especially when the patient is standing, coughing, or straining 1. The examiner should gently palpate the area to feel for a soft, reducible mass that may disappear when the patient is lying down. It is also important to note any pain, discomfort, or tenderness at the site.
Key Diagnostic Steps
- A thorough medical history is crucial, focusing on previous surgeries, when symptoms began, and any factors that worsen the condition such as heavy lifting or pregnancy.
- The physical examination should include having the patient stand and possibly cough while the area is examined.
- Imaging studies may be necessary for confirmation, with ultrasound being a reasonable first-line option due to its accessibility and lack of radiation.
- CT scans can provide more detailed information about the hernia's size and contents, particularly in complex or recurrent cases.
- MRI might be used in specific situations where further detail is needed.
The importance of prompt diagnosis cannot be overstated, as untreated hernias can lead to serious complications including bowel obstruction or strangulation, which would require emergency surgery 1. Therefore, a combination of clinical judgment, physical examination, and judicious use of imaging studies is recommended for the diagnosis of incisional hernias.
From the Research
Diagnosis of Incisional Hernia
To diagnose an incisional hernia, the following methods can be used:
- Physical examination: This is the most common method used to diagnose incisional hernias 2. However, it may be difficult to diagnose small incisional hernias or those in obese patients 3.
- Ultrasonography: This can be used in addition to physical examination to diagnose incisional hernias, especially in cases where physical examination is difficult 3.
- Computed Tomography (CT) scan: This can be used to diagnose incisional hernias, especially in overweight patients where physical examination may be challenging 2.
Diagnostic Criteria
There are no clear diagnostic criteria for incisional hernia available in the literature 3. However, an incisional hernia can be defined as any detectable defect in the abdominal wall with intra-abdominal contents protruding beyond the aponeurosis 2.
Imaging Techniques
Different imaging techniques can be used to diagnose incisional hernias, including:
- Ultrasonography: This is a useful tool for diagnosing incisional hernias, especially in cases where physical examination is difficult 3.
- Computed Tomography (CT) scan: This can be used to diagnose incisional hernias, especially in overweight patients where physical examination may be challenging 2.
- Magnetic Resonance Imaging (MRI): This has higher sensitivity and specificity than ultrasonography and can be used to diagnose occult hernias if clinical suspicion is high despite negative ultrasound findings 4.