This document discusses using ultrasound to evaluate abdominal wall hernias. It begins by defining hernias and explaining how ultrasound can be used to identify the location and contents of hernias, as well as complications. The main types of abdominal wall hernias are then described. The document emphasizes that the key to sonographic hernia diagnosis is demonstrating movement of contents during dynamic maneuvers like Valsalva. Examples of ultrasound images of various hernias are provided. The conclusion states that ultrasound allows real-time evaluation and detection of hernias as well as other abdominal wall pathologies, and should be used as the initial examination technique.

1. ABDOMINAL WALL HERNIAS: Ultrasound Approach
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Fig.1
50-year-old female with nonincarcerated right spigelian hernia. A) Longitudinal sonogram shows fatty tissue and
small amount of free fluid. B)en un barrido extendido se demuestra mejor la hernia C) con reconstrucción en 3D se
observa las diferentes capas compromete la hernia.
A)
B)
C)
D)C)
Fig 3. 50-year-old man with incarcerated right lumbar hernia. Longitudinal sonogram
shows fatty tissue persist with Valsalva maneuver A) and relaxation B)
A) B)
A) B)
C)
Fig 4. 46-year-old female with incarcerated midline hernia. Longitudinal (A) and
transverse (B) sonograms show dilated, fluid-filled small-bowel loop and small
amount of free fluid in hernia. Extended scan C) show ...
INTRODUCTION
Hernias are defined as "a protrusion of a part or structure through the tissues
normally containing it." Thus, the fat within a hernia need not be intraperitoneal in
origin, symptomatic Indirect inguinal, femoral, Spigelian and Line Alba hernias, may
contain only properitoneal fat. Unfortunately, it is not always possible to determine
sonographically whether fat is intraperitoneal or properitoneal in origin. Sonography is
an accurate means of identifying abdominal wall hernias when the clinical diagnosis
is uncertain.
Sonography can determine the anatomic location of the hernia, the contents and
complications such as incarceration, bowel obstruction, volvulus and strangulation.
The sonographic contrast between hernia contents and surrounding abdominal wall
tissues is low, the key to diagnosis in most cases is demonstration of the movement
of hernia contents during dynamic maneuvers. During the Valsalva maneuver the
hernia contents move distally and the hernia widens. During the relaxation after
Valsalva the hernia contents move back toward the abdomen and the sac narrows.
Abdominal wall hernia type is determined by site of origin, which is limited to areas
where aponeurosis and fascia are not protected by overlying striated muscle. There
are two main categories groin hernias and anterior abdominal wall hernias. Groin
hernias include indirect and direct inguinal and femoral types. Anterior abdominal wall
hernias include umbilical, linea alba (epigastric and hypogastric), Spigelian, and
incisional types.
The anatomy differs for each hernia type, however the principles of scanning remain
the same.
Sonography will reveal abdominal wall lessions other than a hernia, including a
lipomas, an enlarged lymphs nodes, a metastasis, a suture granuloma, and an
abscess.
CONCLUSION
Sonography is the only imaging modality that allows real-time evaluation of the hernia
and its contents. However, sonographic diagnosis of hernias can be difficult, It is
essential to be familiar with the sonographic anatomy, the variable appearances and
locations of abdominal wall hernias. The exam can detect not only abdominal wall
hernias but also others pathologies including lymphomas, abscess, tumors, lymph's
nodes and granulomas.
This method should be an initial examination ......
A) B)
A) B)
Fig 2. 65-year-old man with nonincarcerated left indirect inguinal hernia.
A) Longitudinal sonograms with Valsalva maneuver B) and relaxation
show properitoneal fatty tissue, moving into inguinal ring C Y D extended
scan in repose y conmaniobra de Valsalva