CT Order for Groin Hernia with Contrast
Order a CT abdomen and pelvis with IV contrast for evaluation of groin hernia in patients with normal renal function and no contrast allergies.
Specific Order Components
Essential Elements to Include
Specify "CT abdomen AND pelvis with IV contrast" - not just abdomen alone, as groin hernias require visualization of the entire pelvis to capture the hernia defect and surrounding anatomy 1
Request multiplanar reconstructions to increase accuracy in locating the hernia defect and transition zones 1
Do NOT order oral contrast - it is unnecessary for hernia evaluation, delays diagnosis, and increases patient discomfort 1
Contrast Protocol Justification
IV contrast is fundamental for identifying anatomical landmarks, assessing vascular perfusion, and detecting complications like bowel ischemia or strangulation 1
IV contrast enables detection of bowel wall enhancement abnormalities that indicate ischemia, which is critical for surgical planning 1
In patients on dialysis with no residual renal function, iodinated contrast is not contraindicated and can be safely administered 2
Clinical Context for Ordering
When CT is Most Appropriate
Occult or clinically equivocal groin hernias - CT has 92% positive predictive value and 96% negative predictive value for detecting hernias not apparent on physical examination 3
Suspected complications including incarceration, strangulation, or bowel obstruction where immediate surgical planning is needed 1
Post-bariatric surgery patients with suspected internal hernias, where both IV and oral contrast are mandatory to identify anatomical landmarks 1
Anatomical Landmarks CT Will Evaluate
Relationship to pubic tubercle - inguinal hernias are ventral to the pubic tubercle, femoral hernias are dorsal 4
Relationship to inferior epigastric artery - direct inguinal hernias are medial, indirect are lateral 4
Hernia contents - fat, bowel, or other structures within the hernia sac 5
Critical Pitfalls to Avoid
Never order CT without IV contrast for hernia evaluation - it provides limited assessment of vascular structures and cannot adequately visualize complications like ischemia 1
Do not restrict fluids before the scan - dehydration is dangerous and may contribute to acute renal failure, particularly in elderly patients with vascular disease 6
Ensure emergency facilities are available for at least 30-60 minutes post-contrast administration, as severe delayed reactions can occur 6
Sample Order Format
"CT abdomen and pelvis with IV contrast for evaluation of [right/left/bilateral] groin hernia. Request multiplanar reconstructions. No oral contrast needed. Patient has normal renal function and no known contrast allergies."