Diagnostic pitfalls of ventral hernias

Abstract

Background: Despite of relative high frequency of occurring (circa 10% laparotomies) and rather simply diagnostic, ventral hernias could be difficult to recognize. Some diseases mimic hernia and hernia itself in obese patients could be omitted. The paper presents experiences based on single-centre material.
Material and methods: From January 2001 to May 2004, 284 abdominal hernia repairs were performed at the Dept. of General and Endocrine Surgery of the University Hospital in Bydgoszcz. 187 of the above number were large hernias.
Results: In 7 patients the initial diagnosis of abdominal wall hernia was not confirmed intraoperatively. In those cases, the abdominal wall tumors were caused by: malignant infiltration, subcutaneous lipoma, haematoma in the right rectus muscle sheath, inguinal hernia, a giant seroma and free fragment of fractured rib. Diagnosis was stated on the base of the anamnesis and physical examination which was supported in two cases with ultrasonography of abdomen. Despite of this we were not be able to avoid misdiagnosis.
Conclusions: On the base of own experience and current literature the authors stated that the diagnosis of an abdominal hernia, if not certain, especially in obese patients, should be confirmed by modern imaging modalities (US, CT, MRI).