An ultrasound (US) examination of the abdominal wall in a series of 302 patients referred for unrelated reasons yielded a prevalence of paraumbilical hernia in 24.9% of women and 23.3% of men [13]. Diastasis recti, weakened linea alba without disruption, may have a similar presentation. If possible, width should be measured and reported. Hernia CT Abdomen and Pelvis Incidence of incisional hernia of 33% was found by Bjork et al [21] with clinical examination yielding a Kappa of 0.81 and CT yielding Kappas of 0.94 and 0.89, respectively, for supine and prone positioning. In one series with surgical confirmation, CT demonstrated high sensitivity and PPV, both at 100%, in diagnosis of Spigelian hernia [9]. Stoma closure sites are common incisional weak points in the abdominal wall. CT demonstrates a low PPV of 33% with a high negative predictive value (NPV) of 95% in the diagnosis of parastomal hernia [22]. This compares favorably with a clinical detection rate of 14%. There are no specific data differentiating diagnostic efficacy of intravenous (IV) contrast versus noncontrast examination. There are no specific data regarding the use of CT without and with IV contrast, but theoretically, the additional information gained between comparison of a noncontrast and postcontrast series would not be beneficial for hernia detection and characterization. Fluoroscopy Upper GI Series There is no relevant literature regarding the use of fluoroscopy upper gastrointestinal (GI) series in the evaluation of abdominal wall hernia. Fluoroscopy Upper GI Series with Small Bowel Follow-Through Anterior abdominal wall hernia may be diagnosed with fluoroscopic studies. Barium is the most common contrast employed. Hernias are recognized when bowel loops are seen extending beyond the fascial planes, focal luminal narrowing at entry and/or exit sites, and displacement or deformity of bowel loops [23].
Hernia. An ultrasound (US) examination of the abdominal wall in a series of 302 patients referred for unrelated reasons yielded a prevalence of paraumbilical hernia in 24.9% of women and 23.3% of men [13]. Diastasis recti, weakened linea alba without disruption, may have a similar presentation. If possible, width should be measured and reported. Hernia CT Abdomen and Pelvis Incidence of incisional hernia of 33% was found by Bjork et al [21] with clinical examination yielding a Kappa of 0.81 and CT yielding Kappas of 0.94 and 0.89, respectively, for supine and prone positioning. In one series with surgical confirmation, CT demonstrated high sensitivity and PPV, both at 100%, in diagnosis of Spigelian hernia [9]. Stoma closure sites are common incisional weak points in the abdominal wall. CT demonstrates a low PPV of 33% with a high negative predictive value (NPV) of 95% in the diagnosis of parastomal hernia [22]. This compares favorably with a clinical detection rate of 14%. There are no specific data differentiating diagnostic efficacy of intravenous (IV) contrast versus noncontrast examination. There are no specific data regarding the use of CT without and with IV contrast, but theoretically, the additional information gained between comparison of a noncontrast and postcontrast series would not be beneficial for hernia detection and characterization. Fluoroscopy Upper GI Series There is no relevant literature regarding the use of fluoroscopy upper gastrointestinal (GI) series in the evaluation of abdominal wall hernia. Fluoroscopy Upper GI Series with Small Bowel Follow-Through Anterior abdominal wall hernia may be diagnosed with fluoroscopic studies. Barium is the most common contrast employed. Hernias are recognized when bowel loops are seen extending beyond the fascial planes, focal luminal narrowing at entry and/or exit sites, and displacement or deformity of bowel loops [23].