Ultrasonographic evaluation of bilateral groins in children with unilateral inguinal hernia

Abstract

Purpose: The presence of hernia was investigated prospectively by US in both groins of children with clinically suspected or apparent unilateral inguinal hernia. Material and Methods: One hundred and twenty-eight (103 boys, 25 girls) were classified into three groups according to age: 0-2, 3-5 and 6-15 years. The widest diameter of the inguinal canal was measured in the longitudinal plane while the children were in the supine position and at rest. The patent processus vaginalis (PPV) values of 4 mm and higher were accepted as hernia. The groins diagnosed clinically and/or ultrasonographically as hernia were explored surgically. The clinical and US findings were compared with surgical results. The relations between hernia diameters and the age groups, sex, right/left and inguinal/scrotal hernias were analyzed statistically. Results: In 128 children, 138 groins were treated with surgery. One hundred and eleven cases were unilateral hernia (73 right, 38 left) and 10 were bilateral. Seven cases were found to be normal. Ten cases with clinically unilateral hernia were bilateral at US and surgery. One hundred and thirty-one of 138 groins were correctly diagnosed by US. The accuracy, specificity and sensitivity of US were 94.9%, 85.7% and 95.4%, respectively. The accuracy of physical examination was 87.7%. There were no significant differences between hernia diameters and the age groups, sex and right/left side except the difference between inguinal and scrotal hernia diameters ( p<0.0001). Conclusion: US can be used routinely in the pre-operative diagnosis of inguinal hernia in children. PPV values higher than 4 mm, with a high accuracy indicate hernia.