E5371. When There is a Hole, There is a Sac: Name That Hernia
  1. Nabih Nakrour; Massachusetts General Hospital
  2. Soumyadeep Ghosh; Massachusetts General Hospital
  3. Priyanka Prajapati; Massachusetts General Hospital
  4. Mukesh Harisinghani; Massachusetts General Hospital
Abdominal wall hernias, although not the most common, are mostly encountered on different imaging modalities, and hernias' repairs are among the common surgical operations in the United States. Obesity, increased abdominal wall pressure, and abdominal wall weakness are factors in the pathophysiology of most hernias. Different imaging modalities play a role in identifying the hernial sack, neck, and contents, which are important aspects in diagnosing, following, or surgical management. Imaging modalities, including MRI, CT, and sonography (US) are used to assess both the hernial lesion and the associated complications that might arise and mimic other pathologies.

Educational Goals / Teaching Points
• Review common and rare hernias in the abdomen and pelvis in an interactive, case-based presentation. • Discuss relevant anatomic landmarks to the hernia sac. • Provide companion cases of hernia variations and differential subtypes. • Recognize radiologic findings of hernia complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
• Abdominal wall herniation including anterior abdominal wall hernias (such as Spigelian, posterior rectus sheath, Maydl, and Richter hernias), lumbar hernias, groin hernias (such as Amyand hernia), and femoral hernias (such as De Garengeot hernia). • Diaphragmatic hernia, including hiatal hernias with gastric volvulus. • Internal herniation such as left paraduodenal, right paraduodenal fossa, the foramen of Winslow, transmesenteric, transmesocolic, and broad ligament hernias. • Rare hernias such as Littre hernia. • Pelvic hernia such as perineal hernia and sciatic hernias. • Hernia complications such as bowel obstruction and necrosis.

Radiologists must identify the different types of hernias and accurately report their content, extension, and associated complications to better assist in future management.