A Prospective Evaluation of the Role of Clinical Examination, Ultrasonography, and Computed Tomography in the Diagnosis and Management of Abdominal Wall Hernias

Abstract

Background: Abdominal wall hernias are common surgical conditions and may present with swelling, pain, reducibility, obstruction, or strangulation. Although clinical examination is usually sufficient for obvious hernias, ultrasonography (USG) and computed tomography (CT) provide additional diagnostic and anatomical information, particularly in equivocal and complicated cases. The present study evaluated the role and diagnostic performance of clinical examination, USG, and CT in the diagnosis and management of abdominal wall hernias.

Materials and Methods: A prospective observational study was conducted in the Department of Surgery, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, over a period of 6 months. A total of 80 adult patients with clinically suspected abdominal wall hernias were included. All patients underwent detailed clinical examination, followed by USG and CT when clinically indicated. Findings were compared with the final clinical/operative reference diagnosis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were assessed.

Results: The majority of patients were aged 41–50 years (25.0%), and 65.0% were males. Abdominal wall swelling was the most common presenting symptom (95.0%). Inguinal hernia was the most frequent type (45.0%), followed by incisional hernia (22.5%). Clinical examination identified hernias in 92.5% of patients and demonstrated a sensitivity of 97.4% and diagnostic accuracy of 95.0%. USG detected hernias in 96.3% of patients, with a sensitivity of 98.7% and diagnostic accuracy of 98.8%. CT detected hernias in 98.8% of patients and demonstrated 100% sensitivity and 100% diagnostic accuracy in the study dataset. CT also showed better concordance for defect localisation, bowel involvement, obstruction, and strangulation.

Conclusion: Clinical examination remains the essential first-line diagnostic modality for abdominal wall hernias. USG provides high diagnostic accuracy and is particularly useful for dynamic assessment, while CT offers superior anatomical delineation and is especially valuable in complex, recurrent, obstructed, or strangulated hernias. A stepwise approach with selective use of USG and CT can facilitate accurate diagnosis and appropriate preoperative planning.