Post-herniographic abdominal pain syndrome.

PURPOSE: To disclose the frequency of abdominal pain that led to post-procedure hospitalization and the outcome of this major complication. MATERIAL AND METHODS: 576 patients who had undergone herniography during a 13-year period were retrospectively analysed. RESULTS: Nine out of 576 patients (1.6%) undergoing herniography with an iodine contrast medium developed abdominal pain. The pain resolved within 24 h in 6 patients while 3 patients had pain for up to 3 days. CONCLUSION: Patients who present with this pain syndrome thus only need careful clinical observation until asymptomatic, with no need for laparotomy or X-ray examination. Prior to herniography, the patients should be informed about this potential complication.

Herniographic findings in athletes with unclear groin pain.

BACKGROUND: Groin pain in athletes is a common symptom and may, among many other entities, be caused by skeletal changes in the symphysis and the pubic bone or hernia. MATERIAL AND METHODS: Herniographies in 51 athletes -- mainly soccer players -- with unclear groin pain were reviewed. The prevalence of various hernias and skeletal changes at the symphysis and os pubis was registered. A questionnaire was also sent to the patients 3-20 years after the herniography. RESULTS: A hernia was found in 13 patients. Four patients had an indirect inguinal hernia. Eight patients had a direct inguinal hernia and 1 had an obturator hernia. The prevalence of direct inguinal hernia was higher than expected in young men. This may be explained by strain at physical exercise. Bone changes at the pubic symphysis were found in 32 patients, 21 of whom had advanced changes. CONCLUSION: A hernia can be found with herniography in one-fourth of athletes with long-standing unclear groin pain. Therefore herniography should be included in the diagnostic procedure. Lesions of the symphysis may be the result of strain of tendons, ligaments and fascias. This may predispose for an inguinal hernia as well.

MR imaging following herniography in patients with unclear groin pain.

The aims of the present study were to assess if MRI gives the same diagnostic information as herniography concerning the presence of hernias and reveals other causes of groin pain. The prospective study enrolled 20 patients referred for herniography, 6 women and 14 men, mean age 48 years. After herniography the patients underwent MRI using T1-weighted, fat-suppressed inversion recovery (STIR), and magnetic resonance cholangiopancreaticography (MRCP) pulse sequences. No contrast medium was administered at MRI. Herniography revealed 11 hernias and MRI depicted 8 of these. Magnetic resonance imaging depicted well the anatomy in the groins. In 3 patients where hernias were not revealed, MRI revealed inflammatory changes in the symphysis region as a possible cause of groin pain. The primary diagnostic tool for diagnosing hernias is herniography. If the herniogram is normal, MRI may reveal other causes of groin pain and may also better visualize related structures in the groin.

Herniography in women under 40 years old with chronic groin pain.

OBJECTIVE: To find out the prevalence of symptomatic non-palpable groin hernias in women under 40 years old with undiagnosed chronic groin pain. DESIGN: Retrospective analysis. SETTING: University hospital, Sweden. SUBJECTS: 116 women 14-39 years old (mean 27) with chronic undiagnosed groin pain who underwent herniography 1977-1994. INTERVENTIONS: Intraperitoneal injection of 80 ml iodine contrast medium (200 mg I/ml) RESULTS: Hernias were found in 28 patients (24%): 17 in the right groin alone, 6 in the left groin alone and 5 bilaterally. 19 patients had hernias on the symptomatic side only. 17 patients had indirect inguinal hernias and 7 had direct inguinal hernias (which are claimed to be extremely rare in women). CONCLUSION: A hernia is a relatively common finding during herniography in young women with groin pain.

Ipsilateral multiple groin hernias.

BACKGROUND: Recurrence rates after surgical repair of groin hernia vary between 3% and 20%. One possible reason for recurrent hernias are ipsilateral multiple hernias, which might have been overlooked at the primary operation. METHODS: In the present series 1010 patients with unclear groin pain underwent herniography. RESULTS: A total of 314 patients had hernias, and seventy-one (23%) of these had multiple hernias. Ipsilateral multiple hernias were found in 18 (6%) patients. Ipsilateral multiple hernias were present in 9 (6%) of 144 patients with an indirect hernia, in 17 (12%) of 144 patients with a direct hernia, in 5 (21%) of 24 patients with a femoral hernia, and in 3 (23%) of 13 patients with an obturator hernia. The hernias were of indirect, direct, femoral, and obturator types. CONCLUSIONS: The frequency of ipsilateral multiple hernias is much higher than the frequency reported during herniorrhaphy. Such overlooked ipsilateral multiple groin hernias may account for some of the so-called recurrences after herniorrhaphy. Therefore a careful exploration of the groin is mandatory. Preoperative herniography may also prove to be useful in patients with recurrent groin symptoms after herniorrhaphy.

Femoral hernia: clinical significance of radiologic diagnosis.

UNLABELLED: A retrospective study of 18 patients with femoral hernia assessed by herniography is presented. Although a palpable lump was present in 11 patients (61%), the diagnosis of a femoral hernia was not made before herniography. Surgical exploration was performed in 12 patients and a femoral hernia was found and repaired with beneficial outcome in 9 of them. IN CONCLUSION: herniography is of value for the diagnosis of a femoral hernia in patients with obscure groin pain.

The value of herniography in elderly women with groin pain of obscure origin.

In 64 women aged 60-90 (mean 69) years with groin pain of obscure origin (no palpable mass), the diagnostic contribution of positive-contrast herniography was retrospectively evaluated. Groin hernia was found in 28 patients (44%), and was judged to have caused the pain in 18 of them. In 13 of these patients herniorrhaphy relieved the symptoms, and in the other five surgery was contraindicated. The origin of the groin pain in the remaining 46 patients was judged to be musculoskeletal (21), intestinal (11), urogenital (3) or other (11). Herniography thus can substantially contribute in the clinical investigation of groin pain of unclear origin in elderly women.

Position, orientation and component interaction in dislocation of the total hip prosthesis.

The position, orientation in space and interaction of prosthetic components was determined in 15 patients with known episodes of dislocation after total hip replacement. The same calculations were performed in a reference group of 44 patients without dislocation. In the group with dislocations, there was a significantly decreased femoral anteversion, and a decreased femoral flexion permitted by the prosthetic components. There were no further significant differences of clinical relevance between the groups concerning all other examined parameters of component position, orientation and interaction. It is concluded that the decreased range of flexion, caused by impingement of the prosthetic components with ensuing leverage effect is one cause of dislocation.

Inguinal hernia in urological patients: the value of herniography.

The value of herniography was reviewed in 45 patients with a variety of urological symptoms (4 with flank pain, 20 with pain from the funicle or scrotum, 11 with symptoms simulating prostatitis and 10 with ill-defined symptoms from the small pelvis). In no patient was a groin hernia palpable at physical examination. However, herniography revealed an inguinal hernia in 6 patients who underwent herniorrhaphy, whereafter 5 became asymptomatic. We recommend herniography in patients with long-standing obscure groin pain to reveal the presence of a nonpalpable inguinal hernia.

Herniographic appearance of the lateral inguinal fossa.

Herniography frequently reveals clinically undetected groin hernia. Thereby herniography contributes to the clinical work-up in patients with obscure groin pain. However, the distinction between clinically important and unimportant abnormalities within the lateral inguinal fossa can be difficult. This study was therefore designed in order to elucidate the herniographic appearance of the lateral inguinal fossa in patients with obscure groin pain. Herniographic findings were compared with laterality of the patients' symptoms. The lateral umbilical fold was visible in only 47 per cent of the groins. A triangular shaped outpouching from the lateral inguinal fossa and a patent processus vaginalis were found with equal frequency on the left and right side. They were five times as frequent in men as in women. Their presence did not correlate with laterality of the patients' symptoms. Indirect hernias were almost twice as common on the symptomatic side as compared with the asymptomatic side. On the left side they were found twice as often in men as in women while there was no significant sex difference on the right side. Our results show that neither a patent processus vaginalis nor a triangular outpouching from the lateral inguinal fossa correlate with the laterality of the patients' symptoms while true indirect hernias do.