Jenelle Beadle 5/20/2015 Inguinal/Femoral
Type Based on location of defect Contents Fat, fluid, bowel Movement through defect (valsalva) Reducibility (compression) Completely reducible Partial reducible Non-reducible (incarcerated) Size/Extent Diameter of neck/defect Inguinal hernias (e.g. extends into the scrotum)
Incarcerated hernias can result in bowel obstruction and/or stragulation Bowel involvement is a surgical emergency Strangulation = Ischemia Ultrasound Findings Dilated, fluid filled bowel loops Bowel wall thickening Non-peristalsing Free fluid within hernia sac
Inguinal Indirect Direct Femoral
Entire canal is screened in short axis (w/ valsalva) Images are captured in long and short axis Transducer is oriented with the indicator as shown below This can get confusing when in an oblique plane Trans Rt Ing CanalLong Rt Ing Canal
Entire canal is screened in short axis (w/ valsalva) Images are captured in long and short axis Transducer is oriented with the indicator as shown below This can get confusing when in an oblique plane Trans Lt Ing CanalLong Lt Ing Canal
Proximal and Distal Inguinal Canal: Long and short axis Long and short axis w/ valsalva Long and short axis w/ valsalva cine
Cine w/ Valsalva Long Inguinal Canal Prox
Cine w/ Valsalva Trans Inguinal Canal Prox
Cine w/ Valsalva Long Inguinal Canal Dist
Cine w/ Valsalva Trans Inguinal Canal Dist
Proximal and Distal Inguinal Canal: Long and short axis Long and short axis w/ valsalva Long and short axis w/ valsalva cine Femoral Canal Short axis Short axis w/ valsalva Short axis w/ valsalva cine
Cine w/ Valsalva Long Femoral
Cine w/ Valsalva Trans Femoral
Additional documentation will be necessary if a hernia is present. Documentation should describe the following: Hernia type (based on origin) Contents (fat, fluid, bowel) Reducibility (with transducer compression) Extent (using sonographic landmarks) The sonographer’s findings may read something like this: Fat-containing, indirect, right inguinal hernia. Not completely reducible. With valsalva, it extends 1.5cm distal to the lateral pubic tubercle.
Direct Medial Sagittal Canal side wall Indirect Lateral Oblique Deep inguinal ring
Direct & Indirect Can extend through the superficial inguinal ring and into the scrotum