Abstract
Objective:
This study evaluated the diagnostic utility of sonography and Doppler in assessing complicated abdominal hernias, using surgical outcomes as the reference standard.
Materials and Methods:
A gray-scale sonogram was completed in two imaging planes and targeted the area of the suspected herniation. The entire hernial region was systematically evaluated through sweeping and sliding movements with the transducer. The maximal dimension of the hernial defect was measured in centimeters. The contents of the hernia sac were evaluated to document bowel loops, omentum, ovary, and fluid. Vascularity within the herniated tissues was assessed using color and power Doppler, while pulse-wave Doppler was used to evaluate the blood flow and calculate the resistive index (RI).
Results:
Diagnostic imaging identified 14% of cases as uncomplicated, 48% as irreducible, 20% as obstructed, and 18% as strangulated hernias findings that were in close concordance with intraoperative assessments. The correlation between sonographic evaluation and surgical decision-making was strong (Kappa = 0.911, p < .001). Receiver operating characteristic (ROC) analysis using the RI to predict strangulation yielded an area under the curve (AUC) of 0.990 (p < .001), with a cutoff value >0.78 achieving 100% sensitivity and 91.7% specificity. Receiver operating characteristic analysis based on bowel diameter produced an AUC of 0.816 (p = .002); a threshold of >2.9 cm showed 100% sensitivity and 62.5% specificity.
Conclusion:
This cross-sectional analysis confirmed that sonography and Doppler are highly reliable tools in the preoperative evaluation of complicated hernias, demonstrating strong concordance with surgical findings. The RI and bowel diameter emerged as robust diagnostic parameters, significantly enhancing the early identification of hernia complications and informing surgical intervention.
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