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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Cherla DV, Viso CP, Moses ML, et al. Clinical assessment, radiographic imaging, and patient self-report for abdominal wall hernias. J Surg Res. 227:28-34, 2018 07. Observational-Dx 250 patients To determine the prevalence of occult hernias and to assess the abdominal wall quality of life (AW-QOL) among patients with occult hernias. A total of 250 patients were enrolled of whom 97 (38.8%) had a hernia noted on clinical examination and 132 (52.8%) had a hernia noted on radiographic imaging. The prevalence of occult hernias was 38 (15.2%). Patients with no hernia had a median (interquartile range) AW-QOL of 82.5 (55.0-95.3), patients with clinically apparent hernias had AW-QOL of 47.7 (31.2-81.6; P < 0.001), and patients with occult hernias had AW-QOL of 72.4 (38.5-97.2; P = 0.36). 4
2. Kawkabani Marchini A, Denys A, Paroz A, et al. The four different types of internal hernia occurring after laparascopic Roux-en-Y gastric bypass performed for morbid obesity: are there any multidetector computed tomography (MDCT) features permitting their distinction?. Obes Surg. 21(4):506-16, 2011 Apr. Observational-Dx 34 patients To evaluate multidetector row helical computed tomography (MDCT) features of the differentiation of four different types of internal hernia occurring after laparascopic Roux-en-Y gastric bypass performed for morbid obesity. MDCT features of small bowel obstruction (SBO) (n=25, 73.5%), volvulus (n=22, 64.7%), or a cluster of small bowel loops (SBL) (n=27, 79.4%) were inconsistently present and overlapped between the four IH. The following features allowed for IH differentiation: left upper quadrant clustered small bowel loops (p<0.0001) and a mesocolic hernial orifice (p=0.0003) suggested transmesocolic IH. SBL abutting onto the left abdominal wall (p=0.0021) and left abdominal shift of the superior mesenteric vessels (SMV) (p=0.0045) suggested Petersen's hernia. The SMV predominantly shifted towards the right anterior abdominal wall in mesojejunal hernia (p=0.0033). Location of the hernial orifice near the distal anastomosis (p=0.0431) and jejunojejunal suture widening (p=0.0005) indicated jejunojejunal hernia. 3
3. Chang KJ, Marin D, Kim DH, et al. ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction. J Am Coll Radiol 2020;17:S305-S14. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected small-bowel obstruction. No results stated in abstract. 4
4. Scheirey CD, Fowler KJ, Therrien JA, et al. ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain. J Am Coll Radiol 2018;15:S217-S31. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for acute nonlocalized abdominal pain. No results stated in abstract. 4
5. Timmermans L, Deerenberg EB, van Dijk SM, et al. Abdominal rectus muscle atrophy and midline shift after colostomy creation. Surgery. 155(4):696-701, 2014 Apr. Observational-Dx 77 patients To study factors which may attribute to incisional hernia. Postoperative CT were available for 77 patients; of these patients, 30 also had a preoperative CT. Median follow-up was 19 months. A mean shift to the right side was identified after preoperative and postoperative comparison; from -1.3 +/- 4.6 to 2.1 +/- 9.3 (P = .043). Furthermore, during rectus muscle measurements, a thinner left ARM was observed below the level of colostomy. 3
6. Trainer V, Leung C, Owen RE, Venkatanarasimha N. External anterior abdominal wall and pelvic hernias with emphasis on the key diagnostic features on MDCT. [Review]. Clin Radiol. 68(4):388-96, 2013 Apr. Review/Other-Dx N/A To delineate the important anatomical landmarks and key signs on CT of a wide spectrum of external anterior abdominal wall and pelvic hernias. No results stated in abstract. 4
7. Nagarsheth KH, Nickloes T, Mancini G, Solla JA. Laparoscopic repair of incidentally found Spigelian hernia. J Soc Laparoendosc Surg. 15(1):81-5, 2011 Jan-Mar. Review/Other-Dx 3 patients To discuss a series of laparoscopic repairs for Spigelian hernia. There is evidence that supports the use of laparoscopy for both diagnosis and repair of spigelian hernias. There are also reports of successful repairs both primarily and with mesh. In our experience with the preceding 3 patients, we found that laparoscopic repair of incidentally discovered spigelian hernias is a viable option, and we also found that implantation of mesh, when possible, resulted in satisfactory results and no recurrence. 4
8. Stensby JD, Baker JC, Fox MG. Athletic injuries of the lateral abdominal wall: review of anatomy and MR imaging appearance. [Review]. Skeletal Radiol. 45(2):155-62, 2016 Feb. Review/Other-Dx N/A To review the anatomy, the magnetic resonance (MR) imaging approach, and the features and complications of lateral abdominal wall injuries No results stated in abstract. 4
9. Light D, Chattopadhyay D, Bawa S. Radiological and clinical examination in the diagnosis of Spigelian hernias. Ann R Coll Surg Engl. 95(2):98-100, 2013 Mar. Observational-Dx N/A To investigate the accuracy of preoperative imaging and clinical examination in the diagnosis of Spigelian hernias. Overall, correlation with operative findings showed computed tomography (CT) to have a sensitivity of 100% and a positive predictive value (PPV) of 100%. Ultrasonography had a sensitivity of 90% and a PPV of 100%. Clinical assessment alone had a sensitivity of 100% and a PPV of 36%. 3
10. Macchi V, Porzionato A, Morra A, et al. The triangles of Grynfeltt and Petit and the lumbar tunnel: an anatomo-radiologic study. Hernia. 21(3):369-376, 2017 06. Observational-Dx 50 patients To provide radiological data on the anatomy of the lumbar triangles. The superior lumbar triangle showed a mean surface area of 5.10 +/- 2.6 cm(2). In the area of the triangle, the 12th intercostal pedicle and the 1st lumbar branches of the iliolumbar vessels were found in 42 and 46 %, respectively. The inferior lumbar triangle had a mean surface of area 18.7 +/- 8.4 cm(2). In this area, the 2nd, 3rd, and 4th lumbar branches were found in 9, 67, and 8 %, respectively. On oblique coronal images, a direct tunnel between the superior and the inferior lumbar triangles was found, showing an oblique course, with a postero-anterior direction (mean length 36.5 +/- 5.8 mm, mean caliber 7.4 +/- 3.1 mm). 4
11. Wang R, Qi X, Peng Y, et al. Association of umbilical hernia with volume of ascites in liver cirrhosis: a retrospective observational study. J Evid Based Med. 9(4):170-180, 2016 Nov. Observational-Dx 157 patients To evaluate the correlation of umbilical hernia with the volume of ascites. Alkaline phosphatase (AKP) and serum sodium were significantly lower in patients with umbilical hernia (P = 0.008, P = 0.011, respectively). Child-Pugh scores and the volume of ascites were significantly higher in patients with umbilical hernia (P = 0.03, P < 0.0001, respectively). Correlation analysis demonstrated that the volume of ascites, Child-Pugh scores, and blood ammonia had positive correlations with umbilical hernia (r = 0.4579, P < 0.0001; r = 0.175, P = 0.03; r = 0.342, P = 0.001, respectively) and that serum sodium had a negative correlation with umbilical hernia (r = -0.203, P = 0.011). In patients with ascites >/=2000 mL, only AKP was significantly associated with umbilical hernia (P = 0.0497). No variables were significantly associated with umbilical hernia in a subgroup analysis of patients matched according to the volume of ascites. 3
12. Tsukada M, Ozaki A, Ohira H, Sawano T, Nemoto T, Kanazawa Y. [Umbilical Hernia Complicated by Gastrointestinal Stromal Tumor of the Small Intestine - A Case Report]. [Review] [Japanese]. Gan To Kagaku Ryoho. 43(12):1836-1838, 2016 Nov. Review/Other-Dx 1 patient To study a case of GIST complicated by umbilical hernia. No results stated in abstract. 4
13. Bedewi MA, El-Sharkawy MS, Al Boukai AA, Al-Nakshabandi N. Prevalence of adult paraumbilical hernia. Assessment by high-resolution sonography: a hospital-based study. Hernia. 16(1):59-62, 2012 Feb. Observational-Dx 302 patients To determine the prevalence of paraumbilical hernias among adult patients by abdominal sonography in a tertiary care hospital and to describe the sonographic technique and findings. The number of positive cases among females was 42 (24.9%) and that among males was 31 (23.3%). 3
14. Yeo D, Mackay S, Martin D. Single-incision laparoscopic cholecystectomy with routine intraoperative cholangiography and common bile duct exploration via the umbilical port. Surg Endosc. 26(4):1122-7, 2012 Apr. Observational-Dx 60 patients To demonstrate the feasibility of the SILS technique for cholecystectomy with routine IOC (LCIOC) and common bile duct (CBD) exploration as needed via the umbilical port. Of the 60 patients included in the database, 55 (91.7%) successfully underwent single-incision laparoscopic cholecystectomy (SILC), whereas the remaining five patients required conversion to 4PLC. No patient required conversion to open cholecystectomy (OC). Of the 55 successful SILC patients, 53 (88.3%) successfully received IOCs, 48 of which were normal. The remaining five IOCs demonstrated choledocholithiasis, four of which could be managed laparoscopically without the need for conversion to either 4PLC or OC. One patient required postoperative endoscopic retrograde cholangiopancreatography (ERCP). Complications included four wound infections (7.8%), one incisional hernia (2.0%), and one bile leak (3.2%). The operating time ranged from 35 to 180 min and decreased with experience. 3
15. Buckley FP 3rd, Vassaur HE, Jupiter DC, Crosby JH, Wheeless CJ, Vassaur JL. Influencing factors for port-site hernias after single-incision laparoscopy. Hernia. 20(5):729-33, 2016 10. Observational-Tx 787 patients To determine the rate of port-site hernias as well as influencing risk factors for developing this complication. 787 patients who underwent SILS without conversion to open were reviewed. There were 454 cholecystectomies, 189 appendectomies, 72 colectomies, 21 fundoplications, 15 transabdominal inguinal herniorrhaphies, and 36 other surgeries. Cases included 532 (67.6 %) women, and among all patients mean age was 44.65 (+/-19.05) years and mean BMI of 28.04 (+/-6). Of these, 50 (6.35 %) patients were documented as developing port-site incisional hernias by a health care provider or by incidental imaging. Of the risk factors analyzed, insertion-site hernia, age, and BMI were significant. Multivariate analysis indicated that both preexisting hernia and BMI were significant risk factors (p value = 0.00212; p value = 0.0307). Morbidly obese patients had the highest incidence of incisional hernias at 18.18 % (p value = 0.02). 3
16. Kappos EA, Jaskolka J, Butler K, O'Neill AC, Hofer SOP, Zhong T. Preoperative Computed Tomographic Angiogram Measurement of Abdominal Muscles Is a Valuable Risk Assessment for Bulge Formation after Microsurgical Abdominal Free Flap Breast Reconstruction. Plast Reconstr Surg. 140(1):170-177, 2017 Jul. Observational-Dx 589 patients To evaluate the association between preoperative computed tomography angiography-derived measurements of abdominal core muscles and postoperative abdominal wall morbidity after abdominal tissue breast reconstruction. Of the 589 patients who underwent abdominal free flap breast reconstruction, symptomatic bulges/hernias were identified in 35 patients (5.9 percent). When compared to the 70 matched controls, multivariable analysis showed that decreased area of rectus abdominis muscle (OR, 0.18; p < 0.01) and increased inter-rectus abdominis distance (OR, 1.14; p < 0.01) on computed tomographic angiography were significant risk factors associated with postoperative bulge/hernia. 3
17. Donahue TF, Bochner BH. Parastomal hernias after radical cystectomy and ileal conduit diversion. [Review]. Investig Clin Urol. 57(4):240-8, 2016 07. Review/Other-Dx N/A To describe the clinical and radiographic definitions of PH, the clinical impact and risk factors associated with its development, and the use of prophylactic mesh placement for patients undergoing ileal conduit urinary diversion with the intent of reducing PH rates. No results stated in abstract. 4
18. Mirmohammadkhani M, Foroushani AR, Davatchi F, et al. Multiple Imputation to Deal with Missing Clinical Data in Rheumatologic Surveys: an Application in the WHO-ILAR COPCORD Study in Iran. Iran J Public Health. 41(1):87-95, 2012. Review/Other-Dx N/A To demonstrate an application of multiple imputation (MI) for handling missing clinical data in the setting of rheumatologic surveys using data derived from 10291 people participating in the first phase of the Community Oriented Program for Control of Rheumatic Disorders (COPCORD) in Iran. With CCA, percent bias associated with missing data was 8.67 (95% CI: 7.81-9.53) for the proportion and 13.67 (95% CI: 12.60-14.74) for the standard error. However, they were 6.42 (95% CI: 5.56-7.29) and 10.04 (95% CI: 8.97-11.11), respectively using the MI method (M=15). Percent bias in estimating disease proportion and its standard error was significantly lower in missing data analysis using MI compared with CCA (P< 0.05). 4
19. Hotouras A, Murphy J, Power N, Williams NS, Chan CL. Radiological incidence of parastomal herniation in cancer patients with permanent colostomy: what is the ideal size of the surgical aperture?. Int J Surg. 11(5):425-7, 2013. Observational-Dx 43 patients To establish the radiological incidence of herniation in patients with a permanent colostomy and correlate it with the size of the abdominal wall defect in order to identify an aperture diameter associated with a reduced herniation risk. Radiologically, 25/43 (58%) had evidence of a parastomal hernia. The median aperture diameter was 35 mm (range 25-58 mm) in patients with a parastomal hernia and 22 mm (range 10-36 mm) in patients without herniation (p < 0.0001). There were no cases of herniation with an abdominal wall defect size <25 mm. The median follow up was 26.0 months (range 6-55) in patients with herniation as opposed to 16.0 months (range 7-36) in patients without herniation (p = 0.11). 4
20. Gurmu A, Matthiessen P, Nilsson S, Pahlman L, Rutegard J, Gunnarsson U. The inter-observer reliability is very low at clinical examination of parastomal hernia. Int J Colorectal Dis. 26(1):89-95, 2011 Jan. Observational-Dx 41 patients To evaluate the reliability of the diagnosis based on clinical examination and to compare this examination with the result of a specially designed questionnaire and computerised tomography (CT) scan. At Hospital I, 17 patients were examined by three surgeons, with inter-observer kappa values between 0.35 and 0.64. At Hospital II, 13 patients were examined by three surgeons, the kappa values ranged between 0.29 and 0.43. At Hospital III, 11 patients were examined by two surgeons, with kappa value of 0.73. The kappa value between CT scan and the colostomy questionnaire was 0.45. 2
21. Bjork D, Cengiz Y, Weisby L, Israelsson LA. Detecting Incisional Hernia at Clinical and Radiological Examination. Surg Technol Int. 26:128-31, 2015 May. Observational-Dx 24 patients To investigate the correlation between findings at clinical examination and at computed tomography when detecting incisional hernia after midline incisions. For the clinical examination, the Kappa was 0.81. For computed tomography with the patient in the supine position, the Kappa was 0.94 and in the prone position it was 0.89. The Kappa for clinical examination and computed tomography combined was 0.80. 3
22. Bhangu A, Fletcher L, Kingdon S, Smith E, Nepogodiev D, Janjua U. A clinical and radiological assessment of incisional hernias following closure of temporary stomas. Surg.. 10(6):321-5, 2012 Dec. Observational-Dx 59 patients To describe this rate in patients with closed stomas who had definitive post-operative imaging of their abdominal wall. CT scans were performed for 57 patients and MRI for two. The median time from closure to imaging was 10 months (range 3-32 months). The combined clinical and radiological hernia rate was 34% (20/59). Imaging alone produced a rate of 31% (18/59). The clinical rate of hernia detection was 14% (8/59). Using the rate of clinical herniation as the detection standard, imaging had a low positive predictive value (33%, 6/18) but a high negative predictive value (95%, 39/41). Four patients required surgical repair of their stoma site hernia (20%, 4/20). 3
23. Zafar HM, Levine MS, Rubesin SE, Laufer I. Anterior abdominal wall hernias: findings in barium studies. [Review] [19 refs]. Radiographics. 26(3):691-9, 2006 May-Jun. Review/Other-Dx N/A To review anterior abdominal wall hernia findings in barium studies. No results stated in abstract. 4
24. Gokhale S. Sonography in identification of abdominal wall lesions presenting as palpable masses. J Ultrasound Med. 25(9):1199-209, 2006 Sep. 4
25. Beck WC, Holzman MD, Sharp KW, Nealon WH, Dupont WD, Poulose BK. Comparative effectiveness of dynamic abdominal sonography for hernia vs computed tomography in the diagnosis of incisional hernia. J Am Coll Surg. 216(3):447-53; quiz 510-1, 2013 Mar. Observational-Dx 181 patients To determine the comparative effectiveness of surgeon-performed Dynamic Abdominal Sonography for Hernia (DASH) vs CT for incisional hernia evaluation. In patients in whom hernias were identified, the mean hernia size was 44.6 cm(2) (range 0.2 to 468.3 cm(2)). The DASH examination showed high sensitivity (98%) and specificity (88%). Hernia prevalence was 55% in this population, resulting in positive and negative predictive values of 91% and 97%, respectively. Four patients had clinically detectable hernias that were not seen on CT but were discovered with DASH. Inter-rater reliability for DASH was high, with an observed intraclass correlation coefficient of 0.79. 1
26. Zoland MP, Maeder ME, Iraci JC, Klein DA. Referral Patterns for Chronic Groin Pain and Athletic Pubalgia/Sports Hernia: Magnetic Resonance Imaging Findings, Treatment, and Outcomes. American Journal of Orthopedics (Chatham, Nj). 46(4):E251-E256, 2017 Jul/Aug. Observational-Tx 117 patients To present the experience of a tertiary group of physicians specializing in groin pain and athletic pubalgia. Of 117 mostly non-professional athletes, there were 79 MRI-positive cases of athletic pubalgia (68%). Other common findings were acetabular labral tear (57%) and inguinal hernia (35%). Employment of a dynamic MRI protocol increased sensitivity for certain pathologies. Of positive athletic pubalgia cases, 49% went on to have surgical repair. The satisfaction rate in the surgical group was 90% at follow up. Advances in MRI have increased our ability to characterize and diagnose specific injuries causing groin pain. We present our diagnostic algorithm, including an MRI protocol that not only evaluates the groin, but has increased sensitivity for additional findings such as inguinal hernia and abdominal wall deficiencies. 3
27. Burgmans JP, Voorbrood CE, Van Dalen T, et al. Chronic pain after TEP inguinal hernia repair, does MRI reveal a cause?. Hernia. 20(1):55-62, 2016 Feb. Observational-Dx 53 patients To address the yield of MRI in evaluating chronic pain after TEP hernia repair. Fifty-five groins were painful after the initial operation, 12 were pain-free postoperatively and 39 groins were not operated. None of the predefined disorders was observed statistically more often in the patients with painful groins. Only fibrosis appeared more prevalent in patients with chronic pain (P = 0.11). Interobserver agreement was excellent for identifying the mesh (kappa = 0.88) and observing bulging or a hernia (kappa = 0.74) and was substantial for detecting fibrosis (kappa = 0.63). In 40% of the patients, MRI showed a correct mesh position and observed nothing else than minor fibrosis. A wait and see policy resolved complaints in the majority of the patients. In 15 % of the patients, MRI revealed treatable findings explanatory for persisting groin pain. 3
28. Burkhardt JH, Arshanskiy Y, Munson JL, Scholz FJ. Diagnosis of inguinal region hernias with axial CT: the lateral crescent sign and other key findings. [Review]. Radiographics. 31(2):E1-12, 2011 Mar-Apr. Review/Other-Dx N/A To review and label key anatomic structures, present cases of direct and indirect inguinal hernias and femoral hernias, and demonstrate their anatomic differences on axial images. No results stated in abstract. 4
29. Alhambra-Rodriguez de Guzman C, Picazo-Yeste J, Tenias-Burillo JM, Moreno-Sanz C. Improved outcomes of incarcerated femoral hernia: a multivariate analysis of predictive factors of bowel ischemia and potential impact on postoperative complications. Am J Surg. 205(2):188-93, 2013 Feb. Observational-Dx 86 patients To identify clinical and analytic parameters associated with intestinal ischemia in patients with an incarcerated femoral hernia. Eight (9.3%) patients underwent intestinal resection. Factors related to intestinal ischemia were oral anticoagulants intake (odds ratio = 9.6) and a duration of symptoms longer than 3 days (odds ratio = 2.1). There was no relationship between leukocytosis (P = .02) or radiographic signs of intestinal obstruction (P = .28) and bowel resection. 4
30. Kalles V, Mekras A, Mekras D, et al. De Garengeot's hernia: a comprehensive review. [Review]. Hernia. 17(2):177-82, 2013 Apr. Meta-analysis 31 studies To summarize the existing evidence on de Garengeot's hernia, with special emphasis on its clinical presentation and diagnostic approach. Thirty-one studies that encompassed 36 patients (28 women, mean age 71.5 years) with de Garengeot's hernia were included in our analysis. Patients presented with a right groin mass in 35 (97 %) cases. The mass was almost always painful (n = 35, 97 %), while 14 (39 %) of the patients were febrile. Mean duration of symptoms was 5.17 days. Fifty-six percent of the groin masses were erythematous. Leukocytosis was present in 67 % of the patients, and 25 patients underwent imaging investigation with X-ray (n = 11), Ultrasound (n = 5) or Computed Tomography (CT, n = 9). Twenty percent of the Ultrasound and 44 % of the CT studies were diagnostic, leading to an overall rate of 14 % of femoral hernia appendicitis preoperative diagnosis. Eighty-one percent of the patients underwent herniorrhaphy with sutures while a mesh was used in 19 %. Mean hospital stay was 6.23 days. Inadequate
31. Robinson A, Light D, Kasim A, Nice C. A systematic review and meta-analysis of the role of radiology in the diagnosis of occult inguinal hernia. [Review]. Surgical Endoscopy. 27(1):11-8, 2013 Jan. Review/Other-Dx N/A To address  the dilemma posed by occult inguinal hernias. No results stated in abstract. 4
32. Miller J, Cho J, Michael MJ, Saouaf R, Towfigh S. Role of imaging in the diagnosis of occult hernias. JAMA Surg. 149(10):1077-80, 2014 Oct. Observational-Dx 59 patients To determine the effectiveness of imaging-ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI)--in the diagnosis of occult inguinal hernia. The number, sensitivity, specificity, positive predictive value, and negative predictive value of each modality were, respectively: US (9, 0.33, 0, 1.00, and 0), CT (39, 0.54, 0.25, 0.86, and 0.06), and MRI (34, 0.91, 0.92, 0.95, and 0.85). Among multiply imaged groins in which CT examination missed a diagnosis of hernia, MRI correctly detected an occult hernia in 10 of 11 cases (91%). 3
33. Kamei N, Otsubo T, Koizumi S, Morimoto T, Nakajima Y. Prone "computed tomography hernia study" for the diagnosis of inguinal hernia. SURG. TODAY. 49(11):936-941, 2019 Nov. Observational-Dx 914 patients To improve diagnostic accuracy in cases of a suspected inguinal hernia, we perform a "CT hernia study," with the patient lying prone to allow decompression of the structures in the inguinal region. The CT hernia study yielded a diagnosis of inguinal hernia in 861 (94.2%) patients and a condition other than inguinal hernia in 43 (4.7%) patients. Hernia was not detected preoperatively but found intraoperatively in 10 patients (1.1%). Surgery was performed for a collective total of 1029 hernias in 873 patients, and the CT hernia study-based hernia detection rate was 98.3%. We compared the preoperative diagnoses of various types of hernia (Japanese Hernia Society Types I-V) against the intraoperative diagnoses and found that the CT hernia study yielded 95.8% accuracy. 4
34. Hachem MI, Saunders MP, Rix TE, Anderson HJ. Herniography: a reliable investigation avoiding needless groin exploration--a retrospective study. Hernia. 13(1):57-60, 2009 Feb. Observational-Dx 170 patients To assess the role of herniography in the detection of occult groin hernias in patients with history of groin pain. Of the 170 patients who underwent herniography, 84 patients (49%) had positive herniograms, indicating the presence of hernia. Twelve of these were patients with chronic groin pain post hernia repair. All patients reported as having a positive herniogram underwent surgical exploration, which confirmed the presence of herniae, which were repaired and patients reported symptomatic benefit on further follow-up. The remaining 86 patients (51%) had a normal herniogram; 20 patients presented with groin pain after hernia repair and were referred to a pain management team. There were two minor complications of the procedure and no major complications. Twenty patients were prevented from undergoing needless surgical re-exploration by the use of this technique. 4
35. Ward ST, Carter JV, Robertson CS. Herniography influences the management of patients with suspected occult herniae and patient factors can predict outcome. Hernia. 15(5):547-51, 2011 Oct. Observational-Dx 204 patients To analyze the ability of demographic factors and individual symptoms and signs in their ability to predict a positive herniogram. For positive herniograms, only 41 (59%) patients underwent surgery and six (16%) patients were found not to have a hernia. The most common reasons for not proceeding to surgery were herniogram findings thought to be insignificant and the herniogram being positive on the contralateral side. For negative herniograms, despite a negative herniogram, four (3%) patients underwent surgery and a hernia was confirmed in two patients. Regarding predictive symptoms and signs, history of a groin lump and greater patient age were significantly associated with a positive herniogram and a confirmed hernia at surgery. 4
36. Light D, Ratnasingham K, Banerjee A, Cadwallader R, Uzzaman MM, Gopinath B. The role of ultrasound scan in the diagnosis of occult inguinal hernias. Int J Surg. 9(2):169-72, 2011. Observational-Dx 297 patients To examine the role of ultrasound in conjunction with clinical judgment in diagnosing occult inguinal hernias in patients with groin pain. 167 examinations (56%) were positive for a hernia, as a result of which 116 patients underwent surgery. At surgery, a hernia was found in 85 cases and no hernia was found in 31 cases. 130 examinations (44%) were negative for hernia. Six patients proceeded to surgery despite a negative ultrasound due to ongoing pain and a hernia was found in 5 cases. Overall, correlation with surgical findings showed ultrasound to have a sensitivity of 94%. Ultrasound used with clinical judgment has a positive predictive value of 73%. 3
37. Kim B, Robinson P, Modi H, Gupta H, Horgan K, Achuthan R. Evaluation of the usage and influence of groin ultrasound in primary and secondary healthcare settings. Hernia. 19(3):367-71, 2015 Jun. Observational-Dx 267 patients To examine the utilization of groin USS in primary and secondary healthcare settings, and investigated its influence on proceeding to surgery. 267 USS were performed by musculoskeletal radiology specialists; patients were referred for USS by GPs in 98 cases (36.7 %), compared to 169 cases (63.3 %) where the referral for USS was organised by surgeons. Clinical examination by surgeons detected inguinal hernias in 105 groins (39.3 %), and USS detected inguinal hernias in 154 groins (57.7 %). Of 162/267 (60.7 %) cases where clinical examination was negative, 98/162 (60.4 %) also had a negative USS; only five of these patients (5.1 %) underwent surgery. In the 64/162 (39.6 %) cases where only the USS findings were positive, 19/64 underwent surgery (29.7 %). When hernia was detected on both USS and clinical examination (n = 90), 68/90 underwent surgery (75.6 %). For patients who underwent surgery, sensitivity for hernia detection was 80 % for clinical examination versus 96.3 % for USS. 3
38. Alabraba E, Psarelli E, Meakin K, et al. The role of ultrasound in the management of patients with occult groin hernias. Int J Surg. 12(9):918-22, 2014. Observational-Dx 375 patients 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. 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. 3
39. Maisenbacher T, Kratzer W, Formentini A, et al. Value of Ultrasonography in the Diagnosis of Inguinal Hernia - A Retrospective Study. Ultraschall Med. 39(6):690-696, 2018 Dec. Observational-Dx 326 patients To determine the diagnostic value of ultrasonography for inguinal hernias and whether it influences the decision for or against surgery. The findings on ultrasonography were positive in 248 patients and negative in 78 patients. In addition to 201 operated patients, we were able to validate a further 40 patients by means of a questionnaire and the alternative ultrasound diagnoses. The correlation with all three references resulted in a sensitivity of 97 %, a specificity of 77 %, a positive predictive value of 95 %, and a negative predictive value of 87 %. 3
40. Kwee RM, Kwee TC. Ultrasonography in diagnosing clinically occult groin hernia: systematic review and meta-analysis. Eur Radiol. 28(11):4550-4560, 2018 Nov. Meta-analysis 16 studies To provide an updated systematic review on the performance of ultrasonography (US) in diagnosing clinically occult groin hernia. . In the two studies without verification bias, sensitivities were 29.4% [95% confidence interval (CI), 15.1-47.5%] and 90.9% (95% CI, 70.8-98.9%); specificities were 90.0% (95% CI, 80.5-95.9%) and 90.6% (95% CI, 83.0-95.6%). Verification bias or a variation of it (i.e. study limited to only subjects with definitive proof of disease status) was present in all other studies. Sensitivity, specificity, and negative predictive value (NPV) were not pooled. PPV ranged from 58.8 to 100%. Pooled PPV, based on data from ten studies with low risk of bias and no applicability concerns with respect to patient selection, was 85.6% (95% CI, 76.5-92.7%). Proportion of correctly classified hernias, based on data from four studies, ranged between 94.4% and 99.1%. Good
41. Robinson A, Light D, Nice C. Meta-analysis of sonography in the diagnosis of inguinal hernias. [Review]. J Ultrasound Med. 32(2):339-46, 2013 Feb. Meta-analysis 9 studies To investigate the diagnostic accuracy of sonography in the diagnosis of inguinal hernias. In the studies included, sensitivity ranged from 92.7% to 100%; specificity ranged from 22.2% to 100%; the positive predictive value ranged from 83.3 to 100%; and the negative predictive value ranged from 40 to 100%. Sonography has overall sensitivity of 96.6 %, specificity of 84.8%, and a positive predictive value of 92.6%. In cases of diagnostic uncertainty, sonography offers value as an initial imaging modality. It has advantages over other radiologic methods, as it is inexpensive and has minimal complications. Good
42. Lee RK, Griffith JF, Ng WH. High accuracy of ultrasound in diagnosing the presence and type of groin hernia. J Clin Ultrasound. 43(9):538-47, 2015 Nov-Dec. Observational-Dx 151 patients To evaluate the accuracy of ultrasound (US) in diagnosing the the presence and type of groin hernia. The overall rates of sensitivity and specificity of US for diagnosing the presence of groin hernia were 96% and 96%. These rates reflect improvements from 92% and 88% prior to 2011 to 98% and 100% beginning in 2011. In addition, the overall accuracy of US for diagnosing the type of groin hernia was 96%. This also improved over time at our center from 91% prior to 2011 to 98% beginning in 2011. 3
43. Lechner M, Fortelny R, Ofner D, Mayer F. Suspected inguinal hernias in pregnancy--handle with care!. Hernia. 18(3):375-9, 2014 Jun. Observational-Dx 18 pregnant patients To avoid unnecessary surgical exploration for suspected symptomatic groin hernias in pregnancy. 4/18 of the suspected hernias first occurred towards the end of the first, the majority (12/18) in the second, 2/18 in the last trimester and all were suspected after clinical examination only. Most women were referred by their gynaecologists. We found no hernias in any of the women but always noted large varicose veins along the round ligament during CDS. All women gave uncomplicated birth to single children, one by caesarean section. Complaints subsided spontaneously within roughly 2 weeks after delivery. No patient developed a groin hernia until the end of the follow-up period. 4
44. Brandel DW, Girish G, Brandon CJ, Dong Q, Yablon C, Jamadar DA. Role of Sonography in Clinically Occult Femoral Hernias. J Ultrasound Med. 35(1):121-8, 2016 Jan. Observational-Dx 55 patients To evaluate the diagnostic accuracy of sonography in clinically occult femoral hernias and to describe our sonographic technique. In these 55 patients, surgery revealed 15 femoral hernias. Eight femoral hernias occurred in women, and 7 occurred in men. For diagnosing femoral hernias, sonography demonstrated sensitivity of 80%, specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 92%. True-positive cases of femoral hernias have a sonographic appearance of a hypoechoic sac with speckled internal echoes. When examining during the Valsalva maneuver, a femoral hernia passes deep to the inguinal ligament, expands the femoral canal, displacing the normal canal fat, and effaces the femoral vein. 3
45. Niebuhr H, Konig A, Pawlak M, Sailer M, Kockerling F, Reinpold W. Groin hernia diagnostics: dynamic inguinal ultrasound (DIUS). Langenbecks Arch Surg. 402(7):1039-1045, 2017 Nov. Observational-Dx 4951 ultrasound examinations To evaluate the sensitivity and specificity of dynamic inguinal ultrasound (DIUS). The results show that standardized ultrasound examination of the groin area with high-frequency, small-part linear transducers also serves to accurately display femoral and small or occult groin hernias. The high-level specificity (0.9980) and sensitivity (0.9758) are proof of the procedure's quality. 3
46. Mandarry MT, Zeng SB, Wei ZQ, Zhang C, Wang ZW. Obturator hernia--a condition seldom thought of and hence seldom sought. [Review]. Int J Colorectal Dis. 27(2):133-41, 2012 Feb. Review/Other-Dx N/A To review the various facets of obturator hernia diagnosis and management to familiarize surgeons with the condition. Since it is very rare that a mass can be found on inspection of the medial aspect of the thigh and the clinical signs are not always present, hence obturator hernia is a condition which leads to both difficult and delayed clinical diagnosis and consequently having a significant morbidity and mortality rates, especially in the elderly. 4
47. Nasir BS, Zendejas B, Ali SM, Groenewald CB, Heller SF, Farley DR. Obturator hernia: the Mayo Clinic experience. Hernia. 16(3):315-9, 2012 Jun. Observational-Dx 30 patients To compare outcomes of obturator hernia pairs between those who did and did not have a preoperative CT. Between 1950 and 2008, 30 patients (median age 82 years, 29 women) underwent OH repair. The most common presenting signs and symptoms were bowel obstruction (63%), abdominal/groin pain (57%), and a palpable lump (10%). The pathognomonic Howship-Romberg sign was present in 11 patients (37%). The diagnosis was made preoperatively in nine patients: clinically in one (3%) and with CT in eight (27%). Nineteen patients (63%) presented emergently. Primary and prosthetic repair were performed in 23 (77%) and seven (23%) patients, respectively. Small-bowel resection was performed in 14 patients (47%). Perioperative morbidity (30%) and mortality (10%) rates were high. Patients with a preoperative CT were less likely to develop a postoperative complication of any type [odds ratio (OR) 0.8, P = 0.04]; however, time to operation, length of stay, need for bowel resection, and mortality rate did not differ (P = NS). No recurrences were detected at a median follow-up of 2 years (range 0-55). 4
48. Droukas DD, Zoland MP, Klein DA. Radiographic and surgical findings of type I obturator hernias in patients with refractory groin pain. [Review]. Clin Imaging. 55:35-40, 2019 May - Jun. Review/Other-Dx N/A To discuss the commonly missed findings of type I obturator hernias at CT and MRI, as well as correlate these findings with images obtained at the time of laparoscopic repair. No results stated in abstract. 4
49. Light D, Razi K, Horgan L. Computed tomography in the investigation and management of obturator hernia. Scott Med J. 61(2):103-105, 2016 May. Observational-Dx 21 patients To investigate an experience with obturator hernias in the elective and emergency setting. Twenty-one patients were included. The mean age was 66 years old. Eleven were male. There were four emergency presentations. One emergency case presented with small bowel obstruction, while the other three cases presented with groin pain. Two patients had a preoperative computed tomography, which showed an obturator hernia confirmed at surgery. The patient with small bowel obstruction had an open bowel resection alone with no hernia repair. They were discharged with no complications or recurrence on follow-up. The other three cases had a mesh repair (one laparoscopic, one laparotomy, one pre-peritoneal). One patient who underwent a laparotomy died of a post-operative pneumonia. The others were discharged uneventfully. In the elective group of 17 patients, 8 patients were taken for an elective laparoscopic inguinal hernia repair but found to actually have an obturator hernia alone. An obturator hernia was found incidentally with an inguinal hernia in three patients. Five patients were expected to have an obturator hernia on clinical examination alone. At surgery, an obturator hernia was found in three cases. In the other two cases, no hernia was found. One patient had a pre-operative computed tomography, which showed an obturator hernia confirmed at surgery. 4
50. Dulskas A, Poskus E, Jurevicius S, Strupas K. Giant gluteal lipoma presenting as a sciatic hernia. Hernia. 19(5):857-60, 2015 Oct. Observational-Dx 1 patient To report a case of gluteal lipoma protruding into pelvis, displacing rectum with bladder and presenting as a sciatic hernia. Computer tomography (CT scan) demonstrated a large intra- and extra-pelvic fatty mass traversing the greater sciatic foramen. The tumor was surgically removed through lower middle laparotomy approach. Subsequent pathological examination revealed lipoma. The patient recovered uneventfully, was discharged 8 days later. MRI scan was advised following 1 year after the surgery. 4
51. Karasaki T, Nakagawa T, Tanaka N. Sciatic hernia: is it really rare?. SURG. TODAY. 44(6):1079-83, 2014 Jun. Observational-Dx 38 patients To investigate the frequency, risk factors, and prognosis of asymptomatic sciatic hernia. Nine patients (24 %) had concomitant asymptomatic sciatic hernias, five (13 %) of which were bilateral.The body mass index (BMI) was significantly lower in the patients with a concomitant sciatic hernia (17.2 +/- 2.4 kg/m(2)) than in those without a sciatic hernia (19.6 +/- 2.6 kg/m(2); P = 0.02). All patients received treatment for incarcerated obturator hernias, but none underwent repair of the concomitant sciatic hernia because all were non-incarcerated and asymptomatic. None of the patients has had trouble with their untreated sciatic hernia after the obturator hernia treatment. 4
52. Mistry V, Halder A, Saad N. Primary posterior perineal hernia: Incidental CT diagnosis of a rare pelvic floor hernia. J Med Imaging Radiat Oncol 2019;63:222-24. Review/Other-Dx 1 patient To present a case of a rare primary posterior perineal hernia that was identified incidentally on computed tomography. No results stated in abstract. 4
53. Neumann PA, Mehdorn AS, Puehse G, Senninger N, Rijcken E. Perineal herniation of an ileal neobladder following radical cystectomy and consecutive rectal resection for recurrent bladder carcinoma. Ann R Coll Surg Engl. 98(4):e62-4, 2016 Apr. Review/Other-Dx 1 patient To present a case of a perineal hernia formation with prolapse of an ileum neobladder following radical cystectomy and rectal resection for recurrent bladder cancer. No results stated in abstract. 4
54. Hattori Y, Hida T, Nakamura K, Takahashi T, Mitsumori K, Ohnishi H. [A Case of Ureteral Sciatic Hernia Treated with Ureteral Stent]. [Japanese]. Hinyokika Kiyo. 65(7):295-298, 2019 Jul. Observational-Dx 1 patient To describe a case of ureteral sciatic hernia treated with ureteral stent. After the stent wasplaced, the hernia wasrepaired and the hydronephrosiswasres olved. The ureteral stent wasremoved 3 monthslater, and relapse of the ureteral sciatic hernia did not occur, even after 18 months. 4
55. Abutaqa M, Tayeh C, Charafeddine F, Bitar F, Arabi M. Fetal Intra-pericardial Morgagni Hernia with effusion affecting one member of a twin gestation. Echocardiography. 36(5):1014-1016, 2019 05. Review/Other-Dx 1 patient To report the first case of fetal echocardiography and fetal MRI following referral due to large pericardial effusion. No results stated in abstract. 4
56. Jambhekar A, Robinson S, Housman B, Nguyen J, Gu K, Nakhamiyayev V. Robotic repair of a right-sided Bochdalek hernia: a case report and literature review. J. robot. surg.. 12(2):351-355, 2018 Jun. Observational-Dx 1 patient To present a case of an adult with clinical signs of bowel obstruction secondary to a BH which was repaired using a robotic approach. Computed tomography (CT) imaging of the chest and abdomen revealed elevation of the right hemidiaphragm and evidence of small bowel obstruction. The patient was managed conservatively with nasogastric tube placement and bowel rest. He underwent colonoscopy which could not be completed secondary to a transverse colon stricture which was confirmed by barium enema. Upon repeat CT imaging, the patient was found to have herniated colon through a right-sided diaphragmatic hernia which caused colonic narrowing. The patient's intestinal obstruction improved clinically with continued conservative management and he underwent robotic repair of a right posterior diaphragmatic hernia. The hernia defect was closed with interrupted figure of eight Ethibond sutures. A right-sided chest tube was placed. Intraoperatively, the herniated proximal transverse colon was noted to be ischemic and a right hemicolectomy was performed. He recovered well and was discharged home on postoperative day 5. 4
57. Moser F, Signorini FJ, Maldonado PS, Gorodner V, Sivilat AL, Obeide LR. Laparoscopic Repair of Giant Bochdalek Hernia in Adults. J Laparoendosc Adv Surg Tech A. 26(11):911-915, 2016 Nov. Review/Other-Dx 2 patients To present 2 cases of fully laparoscopic repair of giant Bochdalek hernia in adults. No results stated in abstract. 4
58. Lee SY, Kwon JN, Kim YS, Kim KY. Strangulated Morgagni hernia in an adult: Synchronous prolapse of the liver and transverse colon. Ulus Travma Acil Cerrahi Derg. 24(4):376-378, 2018 Jul. Review/Other-Dx 1 patient To present the case of an incarcerated and strangulated MH with synchronous prolapse of the liver and transverse colon. No results stated in abstract. 4
59. Temizoz O, Genchellac H, Yekeler E, et al. Prevalence and MDCT characteristics of asymptomatic Bochdalek hernia in adult population. Diagn Interv Radiol. 16(1):52-5, 2010 Mar. Observational-Dx 1350 patients To determine the frequency of asymptomatic incidental Bochdalek hernias in adults, using multidetector computed tomography (MDCT), and to ascertain any possible relationship between Bochdalek hernia and age, gender, or body mass index (BMI). A total of 171 Bochdalek hernias were identified in 142 of 1350 patients, ranging in age from 25 to 90 years (median age, 57.2), representing a prevalence of 10.5%. Sixty leftsided unilateral Bochdalek hernias (42.2%), 53 (37.4%) rightsided unilateral Bochdalek hernias, and 29 (20.4%) bilateral Bochdalek hernias were detected. Forty-five (31.6%) were categorized as small, 82 (57.8%) were medium-sized, and 15 (10.5%) were large. BMI was < 25 in 62 patients (43.7%), and > or =25 in 80 patients (56.3%). Fourteen patients (9.9%) were young adults, while 86 (60.6%) were middle aged, and 42 (29.6%) were elderly. No statistically significant relationship was found between dimensions or hernia locations and age, gender, or BMI of patients with Bochdalek hernia. 4
60. Kinoshita F, Ishiyama M, Honda S, et al. Late-presenting posterior transdiaphragmatic (Bochdalek) hernia in adults: prevalence and MDCT characteristics. J Thorac Imaging. 24(1):17-22, 2009 Feb. Observational-Dx 3107 patients To determine the prevalence of posterior transdiaphragmatic hernia in a large normal adult population. A total of 525 hernias were identified in 396 of 3107 persons, representing an incidence of 12.7%. Age ranges were 36 to 86 years and average was 62.8 years. The prevalence of the posterior diaphragmatic hernias in the 50s, 60s, and 70s age groups was 10.5% (168/1596), 13.7% (137/1003), and 20.3% (80/394), respectively. All persons were asymptomatic. In 93.7% (492/525) of the hernias, only fat was observed, whereas kidney involvement was observed in 5.5% (29/525). Protruded hernia content extended along the diaphragm, thoracoabdominal wall, and in the intermediate position between these 2 structures in 53.7%, 32.8%, and 13.5% of the hernias, respectively. No significant sequential changes were observed (P=0.082) during our follow-up period (12 to 27 mo). 4
61. Kim DK, Moon HS, Jung HY, Sung JK, Gang SH, Kim MH. An Incidental Discovery of Morgagni Hernia in an Elderly Patient Presented with Chronic Dyspepsia. Korean J Gastroenterol. 69(1):68-73, 2017 Jan 25. Review/Other-Dx 1 patients To report a case of Morgagni hernia. No results stated in abstract. 4
62. Ladiwala ZFR, Sheikh R, Ahmed A, Zahid I, Memon AS. Gastric volvulus through Morgagni hernia and intestinal diverticulosis in an adult patient: a case report. BMC surg.. 18(1):67, 2018 08 29. Review/Other-Dx 1 patient To present a case of a 30 year old woman who presented with a one year history of epigastric burning and indigestion, occasionally associated with pain and vomiting. No results stated in abstract. 4
63. Atef M, Emna T. Bochdalek Hernia With Gastric Volvulus in an Adult: Common Symptoms for an Original Diagnosis. Medicine (Baltimore). 94(51):e2197, 2015 Dec. Review/Other-Dx 1 patient To report a case of a 56-year-old woman diagnosed with epigastric pain. No results stated in abstract. 4
64. Uhlich R, Kerby JD, Bosarge P, Hu P. Diagnosis of diaphragm injuries using modern 256-slice CT scanners: too early to abandon operative exploration. Trauma surg. acute care open. 3(1):e000251, 2018. Observational-Dx 1068 patients To perform a retrospective review of trauma patients from 2011 to 2018 was performed at an American College of Surgeons-verified level 1 trauma center to identify the diagnostic accuracy of CT scan for acute diaphragm injury. One thousand and sixty-eight patients underwent operation after preoperative CT scan. Acute diaphragm injury was identified intraoperatively in 14.7%. Most with diaphragmatic injury underwent 64-slice CT (134 of 157, 85.4%). Comparing patients receiving 64-slice or 256-slice CT scan, there was no difference in the side of injury (left side 57.5% vs. 69.6%, p=0.43) or median injury grade (3 (3, 3) vs. 3 (2, 3), p=0.65). Overall sensitivity, specificity, and diagnostic accuracy of the 256-slice CT were similar to the 64-slice CT (56.5% vs. 45.5%, 93.7% vs. 98.1%, and 89.0% vs. 90.2%). 4
65. Yucel M, Bas G, Kulali F, et al. Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: The role of multislice computed tomography. Injury. 46(9):1734-7, 2015 Sep. Observational-Dx 43 patients To determine the role of multislice computed tomography in the evaluation of left diaphragm in patients with penetrating left thoracoabdominal stab wounds. This study included a total of 43 patients, 39 (91%) males and 4 (9%) females of mean age 30 years (range 15-61 years). Thirty patients had normal tomography results, whereas 13 had left diaphragmatic injuries. An injury to the left diaphragm was detected during the operation in 9 (1 in laparotomy and 8 in diagnostic laparoscopy) of 13 patients with positive tomography for left diaphragmatic injury and 2 (in diagnostic laparoscopy) of 30 patients with negative tomography. Multislice tomography had a sensitivity of 82% (95% CI: 48-98%), a specificity of 88% (71-96%), a positive predictive value of 69% (39-91%), and a negative predictive value of 93% (78-99%) for detection of diaphragmatic injury in penetrating left thoracoabdominal stab injury. 3
66. Leung VA, Patlas MN, Reid S, Coates A, Nicolaou S. Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre. Can Assoc Radiol J. 66(4):310-7, 2015 Nov. Observational-Dx 3225 patients To evaluate the diagnostic accuracy of 64-slice multidetector computed tomography (64-MDCT) for the detection of TDR in patients at our level 1 trauma centre. Of the 3225 trauma patients who presented to our institution, 38 (1.2%) had a TDR. Fourteen of the 38 were excluded as they did not have MDCT before surgery. The study cohort consisted of 20 males and 4 females with a median age of 34.5 years and a median Injury Severity Score (ISS90) of 26. Fifteen had blunt trauma while 9 had a penetrating injury. The overall sensitivity of the radiology reports was 66.7% (95% confidence interval [CI]: 46.7%-82.0%), specificity was 100% (95% CI: 94.1%-100%), positive predictive value was 100% (95% CI: 80.6%-100%), negative predictive value was 88.4% (95% CI: 78.8%-94.0%), and accuracy was 90.6% (95% CI: 82.5%-95.2%). However, only 3 of 9 patients with penetrating injury had a correct preoperative diagnosis. Two of the 6 missed penetrating trauma cases had only indirect signs of injury. 3
67. Eren S, Ciris F. Diaphragmatic hernia: diagnostic approaches with review of the literature. [Review] [52 refs]. Eur J Radiol. 54(3):448-59, 2005 Jun. Review/Other-Dx 21 patients To review diaphragmatic hernia types associated with cases, and discuss the preferred imaging modalities for different DHs with review of the literature. Although its limited findings on DH and indirect findings about the diaphragmatic rupture, plain radiography is firstly preferred technique on DH. We found that ultrasound (US) is a useful tool on DH, on traumatic DH cases especially. Not only it shows diaphragmatic continuity and herniated organs, but also it reveals associated abdominal organ's pathologies. Computed tomography (CT) scan is most effective in many DH cases. It shows the herniated abdominal organs together with complications, such as intestinal strangulation, haemothorax, and rib fractures. We stressed that Multislice CT scan with coronal and sagittal reformatted images is the most effective and useful imaging technique on DH. 4
68. Sutedja B, Muliani Y. Laparoscopic repair of a Bochdalek hernia in an adult woman. Asian j. endosc. surg.. 8(3):354-6, 2015 Aug. Review/Other-Dx 1 patient To present a case of a 51-year-old woman who presented with progressive dyspnea and abdominal symptoms. No results stated in abstract. 4
69. Garofano-Jerez JM, Lopez-Gonzalez Jde D, Valero-Gonzalez MA, Valenzuela-Barranco M. Posterolateral Bochdalek diaphragmatic hernia in adults. Rev Esp Enferm Dig. 103(9):484-91, 2011 Sep. Observational-Dx 3 patients To describe and compare three cases of Bochdalek hernia. In one patient, the right kidney was adjacent to the diaphragmatic defect but remained within the abdomen. The patients showed no symptoms and were not surgically treated. Examination by multislice CT with the possibility of coronal and sagittal reconstruction should be considered the standard method for diagnosing this entity. MRI in T1 is highly valuable to evaluate fat-containing chest lesions. The incidental finding of BH in asymptomatic adults is increasing, thanks to the wider application of new imaging techniques. 4
70. Okan I, Bas G, Ziyade S, et al. Delayed presentation of posttraumatic diaphragmatic hernia. Ulus Travma Acil Cerrahi Derg. 17(5):435-9, 2011 Sep. Observational-Dx 10 patients To review patients who presented with delayed posttraumatic diaphragmatic hernia. Mean duration between trauma and presentation to the hospital was 5.9 years (4 months - 19 years). Nine patients had left-sided diaphragmatic hernia. All patients had chest X-ray and most were diagnostic (n: 8). Additional diagnostic imaging with computerized tomography (CT) and magnetic resonance (MR) was used in seven patients. For the repair, laparotomy incision was chosen for seven patients and thoracotomy incision for two patients. One patient underwent left thoracoabdominal approach. Mesh repair was used in seven patients. Postoperative mean hospitalization was 10.6 days. Empyema and atelectasis were the morbidities in one patient. No postoperative mortality was detected. 4
71. Corbellini C, Costa S, Canini T, Villa R, Contessini Avesani E. Diaphragmatic rupture: A single-institution experience and literature review. Ulus Travma Acil Cerrahi Derg. 23(5):421-426, 2017 Sep. Observational-Dx 14 patients To examine and improve our understanding of the etiology, clinical presentation, and management of diaphragmatic rupture. Fourteen patients were diagnosed with DR, mainly left-sided DR. Road traffic collisions were the main causes (86%). DR diagnosis was preoperatively established in eight patients (57%). Chest X-ray was diagnostic in 50% of the patients and computed tomography in three patients (60%). Twelve patients had a diaphragmatic hernia. DR was repaired with a mesh in two patients. Mean hospital stay was 16.6 days. 4
72. Hirano ES, Silva VG, Bortoto JB, Barros RH, Caserta NM, Fraga GP. Plain chest radiographs for the diagnosis of post-traumatic diaphragmatic hernia. Rev. Col. Bras. Cir.. 39(4):280-5, 2012 Jul-Aug. Observational-Dx 45 patients To describe changes in the radiographic examination of the chest in patients with post-traumatic diaphragmatic hernia (PTDH) confirmed intra-operatively. CXR was performed on 32 patients, predominantly male (27 cases, 84.4%) and the mean age was 34 years. The most common cause of injury was blunt trauma (25 cases, 78.1%). Radiographic examination of the chest showed changes suggestive of PTDH in 26 cases (81.3%). During exploratory laparotomy, left PTDH was found in 28 cases (87.5%) and right in four (12.5%). The most frequently herniated organ was the stomach. 3
73. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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