title: The role of ultrasound in the management of patients with occult groin hernias.
abstract: BACKGROUND
  Groin ultrasound scanning is commonly used to examine patients with obscure groin pain or swelling. A recent study has shown ultrasound has a poor positive predictive value (PPV) in diagnosing groin hernias although earlier studies reported PPV values as high as 100%. Our aims were to calculate ultrasound's accuracy in diagnosing occult groin hernias in symptomatic patients and assess how management of these patients is affected by ultrasound result.
  
  
  METHODS
  We retrospectively analysed 375 symptomatic adult patients, who between February 2008 and March 2010, had ultrasound to diagnose groin hernias when clinical examination was inconclusive. Patients were identified on a prospective radiology database and all groin ultrasounds were performed by either one consultant radiologist or one radiographer.
  
  
  RESULTS
  Ultrasound was positive in 199 patients, of which 118 underwent surgery. Using operative findings as the gold standard, ultrasound's PPV for groin hernias was 70% (95% CI: 62-78%). Ultrasound was equivocal in 42 patients of which hernias were diagnosed in 7 of the 10 who had surgery. Ultrasound was negative in 151 patients of which none were later diagnosed with hernias during 3 years' median follow-up.
  
  
  CONCLUSIONS
  Ultrasound is poor in diagnosing occult groin hernias with a PPV of 70% suggesting a 30% chance of negative groin exploration. The equivocal ultrasound group requires careful follow-up as a considerable number were later diagnosed with hernia. The absence of subsequent hernia diagnosis in the negative ultrasound group suggests it may be a useful rule-out test to exclude occult groin hernias in symptomatic patients.
authors.affiliation: Royal Liverpool University Hospital, Department of Surgery, Liverpool L7 8XP, United Kingdom. Electronic address: Edward.alabraba@liverpool.ac.uk.
authors.forename: E
authors.initials: E
authors.lastname: Alabraba
authors.affiliation: University of Liverpool, Molecular and Clinical Cancer Medicine, Liverpool L69 3GA, United Kingdom.
authors.forename: E
authors.initials: E
authors.lastname: Psarelli
authors.affiliation: Royal Liverpool University Hospital, Department of Radiology, Liverpool L7 8XP, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Meakin
authors.affiliation: Royal Liverpool University Hospital, Department of Surgery, Liverpool L7 8XP, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Quinn
authors.affiliation: Royal Liverpool University Hospital, Department of Surgery, Liverpool L7 8XP, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Leung
authors.affiliation: Royal Liverpool University Hospital, Department of Surgery, Liverpool L7 8XP, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Hartley
authors.affiliation: Royal Liverpool University Hospital, Department of Surgery, Liverpool L7 8XP, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Howes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006119:Groin; D006552:Hernia, Inguinal / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017699:Pelvic Pain / Q000000981:diagnostic imaging / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
keywords: Groin hernia; Occult; Ultrasound