ARRS 2022 Abstracts

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E1468. External Abdominopelvic Hernias: A Comprehensive Assessment with Ultrasound
Authors
  1. Michael Nelson; Baylor Scott & White Medical Center
  2. Ricardo Garza-Gongora; Baylor Scott & White Medical Center
  3. Connie So; Baylor Scott & White Medical Center
  4. Krista Birkemeier; Baylor Scott & White Medical Center
  5. Barrett Luce; Baylor Scott & White Medical Center
Background
Ultrasound is increasingly utilized in the assessment of patients with abdominal or groin masses and pain. The importance of accurate classification and surgical preoperative planning cannot be overstated in terms of improving patient outcomes. Ultrasound allows for real-time diagnostics with relatively high sensitivity and specificity while reducing radiation exposure relative to other imaging modalities. This exhibit is designed to provide a helpful review of the pertinent anatomy of the abdominal wall and inguinal canal, to discuss the various types of abdominopelvic hernias, and to present specific cases which highlight the sonographic features of many of the types of hernias encountered in clinical practice.

Educational Goals / Teaching Points
At the end of this presentation, the learner will be able to describe the anatomy of the abdominal wall musculature, fascial layers, and inguinal canal. They will also be able to compare the various types of external abdominopelvic hernias including their unique features, anatomic location, etiology, and associated complications. Finally, they will be able to differentiate sonographic features of various external abdominopelvic hernias, with correlation on CT and MRI.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomy of the abdominal wall and inguinal canal will be reviewed to provide a background for the location of abdominopelvic hernias with reference to specific landmarks including the linea alba, linea semilunaris, inferior epigastric artery, and inguinal ligament, among others. Following a review of the anatomy, the exhibit will discuss the features seen with midline ventral hernias, lateral abdominal wall hernias (spigelian, interparietal, lumbar, parastomal, incisional), groin hernias (direct/indirect inguinal, femoral), pelvic hernias, and other miscellaneous hernias including Amyand, Littre, Richter, and Maydl hernias. The sonographic appearance of various complications including bowel obstruction, incarceration, and strangulation will also be described.

Conclusion
Ultrasound is an invaluable tool in the evaluation and diagnosis of each type of abdominopelvic hernia. The imaging modality is relatively inexpensive, widely available, without radiation exposure, and capable of real-time diagnostics with high sensitivity and specificity. It does, however, require knowledge of anatomic landmarks to correctly classify the hernia type. This image-rich educational exhibit intends to provide our audience with a greater understanding of the pertinent anatomy and defining sonographic characteristics essential for interpreting the various external abdominopelvic hernia types and their potential complications.