Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
Patients often arrive with a scan already done, or expecting one to be ordered. For many hernias neither is necessary.
A hernia that can be seen and felt, that comes and goes with standing and coughing, is diagnosed by examination. A scan is requested when it will answer a question that examination cannot. Knowing what that question is tells you which scan is sensible.
Which scan answers which question
| The question | The scan | Why |
|---|---|---|
| Is this lump a hernia at all? | Usually none. Examination answers it. | A lump with a cough impulse that reduces on lying down is a clinical diagnosis. |
| Groin pain, but nothing I can feel | Ultrasound | Quick, no radiation, and done while you stand and strain. |
| Is it a hernia, a node, a lipoma or a cyst? | Ultrasound | Each of those has its own appearance and behaviour on the scan. |
| Is there a small one on the other side too? | Ultrasound | Both sides can be checked in the same sitting. |
| Large hernia, or several along an old scar | CT | Measures every defect and shows the state of the muscle on each side. |
| It has come back after a repair | CT | Locates the old mesh and shows what is left to work with. |
| Could the bowel be trapped? | CT, urgently | Answers the obstruction question as well as the hernia one. |
Bring every scan and report you already have. It often saves repeating one.
A typical reducible inguinal or umbilical hernia in a slim patient, with a clear cough impulse, usually needs no imaging before a decision is made.
Routine pre-operative blood tests and fitness checks are a separate matter from imaging of the hernia itself.
Ultrasound is quick, involves no radiation, and can be done with you standing and straining.
Its limitation is that it depends on the person doing it, and it sees poorly through a thick abdominal wall. A scan done lying still can miss a hernia that only appears on standing, and a normal report then tells you very little.
CT is the scan for the abdominal wall as a whole. It earns its place when the hernia is large, when there are several defects along an old scar, when a previous repair has failed, or when examination is unreliable because of body size.
For large hernias the measurements on the CT are what the operation is planned from. The scan is worth having before the consultation about surgery, not after it.
MRI is used selectively, mainly for athletic groin pain, where a muscle or tendon injury has to be separated from a hernia.
Endoscopy and a barium swallow belong to hiatal hernia, which behaves quite differently from abdominal wall hernias.
Examination findings carry weight. Ultrasound can miss a hernia that only appears on straining or in a thick abdominal wall. The next step is a proper examination, and sometimes a repeat or different scan.
Often, particularly when bowel obstruction or other abdominal disease is being assessed. It is decided by the question the scan has to answer and your kidney function.
No. Many straightforward hernias are operated on the basis of examination. Imaging is used where it changes the diagnosis or the operation.
Yes, ultrasound and CT both measure the defect. The CT measurement is the one used to plan large abdominal wall repairs.
For a single planning scan in an adult the dose is modest and is justified where the result changes the operation. It is not ordered where an ultrasound or examination will do.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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