Dynamic power Doppler ultrasonography of anterior abdominal wall hernias: confirmation of incarceration.
OBJECTIVE
Power Doppler ultrasonography (PD-US) is a motion-sensitive modality that can display flow characteristics regardless of the direction. This increased motion sensitivity can be used as a parameter to show the tissue motion on artificially generated fremitus images. This study aimed to confirm any signs of incarceration in abdominal wall hernias proven by herniorrhaphy by examination with dynamic PD-US (during manual compression-decompression maneuvers).


METHODS
Twenty-seven patients with anterior abdominal wall hernia with a narrow neck (<1 cm in diameter) were examined firstly with gray-scale ultrasonography (GS-US), and then with dynamic PD-US. Two independent radiologists, who were blinded to the real-time images showing the orientation and motion of the hernia neck, completed the examinations. These images were evaluated for any signs of incarceration, as well as the orientation of the hernia neck.


RESULTS
Orientations of the hernia neck were not described on GS-US images in 13 lesions and on dynamic PD-US images in 3 lesions. While the GS-US examination revealed incarcerated hernia in four of the patients, the dynamic PD-US examination revealed an additional seven patients with symptoms associated with incarceration.


CONCLUSIONS
Dynamic PD-US may show the orientation of the hernia neck and any sign of incarceration more accurately and clearly than conventional GS-US. Being informed about these features preoperatively is of utmost importance. Thus, anterior abdominal wall hernias should be examined by dynamic PD-US.
Department of Radiology, Iskenderun Military Hospital, Iskenderun, Turkey. yildirimduzgun@yahoo.com.
Duzgun
D
Yildirim
Department of General Surgery, Faculty of Medicine, Yeditepe University, Istanbul, Turkey.
Baki
B
Ekci
Department of Radiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey.
Bengi
B
Gurses
Department of General Surgery, Iskenderun Military Hospital, Iskenderun, Turkey.
Mutlu
M
Sahin
Department of Radiology, VKV American Hospital, Istanbul, Turkey.
Terman
T
Gumus
Fremitus; Hernia; Incarceration; Power Doppler ultrasonography