Abstract
Background
Point-of-care ultrasound (POCUS) is an optimal imaging modality for the risk stratification
of patients presenting to the emergency department (ED) with inguinal and femoral
hernias, allowing for better evaluation of clinical presentations and guiding appropriate
treatment. The lack of ultrasound classification for inguinal and femoral hernias
has led to inconsistent use and often underuse of POCUS in this patient population.
Several groin hernia classifications are available, but most are complex and often
targeted toward surgical management.
Objectives
The objective of this study is to review the use of POCUS in the diagnosis of inguinal
and femoral hernias, providing a synopsis of critical ultrasound findings in determining
signs of incarceration, strangulation, and small bowel obstruction, and suggesting
a simple and educative sonographic classification for inguinal or femoral hernias.
Discussion
POCUS can reliably confirm the presence of groin hernias and can uniquely identify
specific ultrasound findings predictive of complications, such as aperistaltic nonreducible
bowel loops, free fluid in the hernia sac, and lack of color doppler in the entrapped
mesentery and bowel walls. POCUS can also aid in determining the presence of small
bowel obstruction by detecting dilated loops of bowel >25 mm adjacent and proximal
to the hernia site.
Conclusions
In the ED, POCUS can confirm the presence of a hernia sac and identify and predict
surgical emergencies, such as bowel incarceration or strangulation, which are the
most important elements in the management of patients presenting with possible inguinal
or femoral hernias.
Keywords
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Article info
Publication history
Published online: May 04, 2022
Accepted:
April 25,
2022
Received in revised form:
April 18,
2022
Received:
February 10,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
