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Hi Stephen,
I would like to check a groin ultrasound (US) with you, if you don’t mind. I have two similar cases from two consecutive days where the previous US reported a direct hernia. The patients came back for a follow-up US to check the size of the hernia.
I could not see any hernia but did note mild to moderate fascial laxity. However, since two separate cases with the same sonographic appearances were called a direct hernia by my colleague sonographers, I’m confused myself. I even had to get our radiologist to come and check them.
Please have a look at the attached dynamic assessments in transverse and longitudinal views and let me know your thoughts. Thank you heaps. -
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I call this posterior wall laxity.
There is no defect in the posterior wall and the fat never enters the canal and hence no fat will exit the superficial ring,But the posterior wall is very weak.
This is a common finding in older males.
If you compare it to the linea alba in the anterior abdominal wall, what you have sent me is like divarication or diastasis of the luna alba where there is laxity but no defect and the fat is not passing through the linea alba, rather the linea alba is just poorly supported and lax. Whereas a direct inguinal hernia is like a ventral hernia where there is a defect in the linea alba with fat passing through it.
I am going to have my IT folk move this thread to the hernia forum so we can continue the discussion.
Great cases.
Steve.
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