From the Guidelines
The patient should undergo an ultrasound evaluation for a possible hernia as requested, given her report of a "popping" sensation in her abdomen for the past three months, despite being asymptomatic with no abdominal pain or constipation. This recommendation is based on the principle of evaluating and potentially treating conditions that could impact her upcoming gallbladder surgery or overall health 1. The sensation she describes could be consistent with a hernia, and an ultrasound is a reasonable non-invasive imaging study to assess for abdominal wall defects.
Key considerations in her management include:
- Completing her COVID and flu testing to clear her for the pending gallbladder surgery.
- Coordinating care with her general surgery team, who are already following her for the gallbladder issue.
- If a hernia is identified on ultrasound, communicating this information to her surgical team, as they may want to address both issues during the same procedure if clinically appropriate, considering the guidelines for managing surgical patients during the COVID-19 pandemic 1.
- Recognizing that hernias can sometimes be asymptomatic but may progress to cause pain, bowel obstruction, or strangulation if left untreated, which justifies evaluation despite her current lack of symptoms.
In the context of her upcoming surgery and the current pandemic, it's crucial to follow guidelines that prioritize her safety and the effectiveness of her treatment plan, such as those outlined for surgical patients during the COVID-19 pandemic 1.
From the Research
Patient's Condition and Request
- The patient is in the clinic for repeat testing of COVID and the flu.
- The patient reports needing upcoming gallbladder surgery, which was delayed due to having the flu.
- The patient has a follow-up with general surgery.
- The patient reports thinking that she had a hernia in her abdomen starting 3 months ago, with a feeling of it popping.
- The patient would like an ultrasound for this condition.
- The patient denies constipation or abdominal pain.
Relevant Studies for Abdominal Ultrasound and Hernia Diagnosis
- A study from 2014 2 emphasizes the importance of a correct examination procedure for abdominal ultrasound, suggesting a systematic approach to scanning the abdominal organs.
- Another study from 2014 3 discusses the use of imaging modalities for adult abdominal hernias, stating that ultrasound is useful for adult groin assessment and is the imaging modality of choice for pediatric abdominal wall hernia assessment.
- A study from 1986 4 highlights the advantages of abdominal ultrasound, including its non-invasive nature and portability, and its utility in diagnosing abdominal aortic aneurysm and visualizing the gallbladder.
Considerations for Gallbladder Surgery and Ultrasound
- A study from 2015 5 evaluates the efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients, showing promising results.
- A study from 2000 6 discusses the management of gallbladder cancer, emphasizing the importance of careful ultrasound screening and CA19-9 serum determination prior to routine cholecystectomy.