Audit of ultrasound and decision to operate in groin pain of unknown aetiology with ultrasound technique explained

Clin Radiol. 2009 Jun;64(6):608-14. doi: 10.1016/j.crad.2008.11.006. Epub 2009 Apr 10.


Aim: To determine the ability of a groin ultrasound service to identify inguinal/femoral hernias in patients with groin pain and equivocal clinical signs, and to evaluate the number of positive cases undergoing surgery.

Methods and materials: A retrospective review of 243 examinations performed during the period January 2000 to June 2004 was undertaken. The referral information, as well as details of the examination and subsequent follow-up, were obtained through our hospital/radiological information system.

Results: Of 243 patients, 92 (38%) were referrals from general practitioners and 151 (62%) were hospital referrals. The examinations were performed by radiology consultants or specialist registrars, the former accounting for 228 examinations (94%). The age range of the patients was 3 months to 88 years (mean age=48.7), with a male to female ratio of 3.2:1. One hundred and forty-three examinations were negative for hernias. Two of these patients underwent groin explorations and were found to be normal. The rest were discharged and none returned with related complaints. Ninety-four examinations (39%) were positive for hernias, as a result of which 62 patients underwent surgery. Of these, only four were found to be false-positives giving a positive predictive value of 94% in operated patients. Three scans were equivocal, and three were positive for other conditions.

Conclusion: In patients with equivocal clinical signs, groin ultrasound is a useful tool for identifying hernias, and therefore, aids surgical management.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Decision Making
  • Diagnosis, Differential
  • Female
  • Groin / diagnostic imaging
  • Groin / surgery
  • Hernia, Femoral / diagnostic imaging*
  • Hernia, Femoral / surgery
  • Hernia, Inguinal / diagnostic imaging*
  • Hernia, Inguinal / surgery
  • Humans
  • Infant
  • Male
  • Medical Audit
  • Middle Aged
  • Pain / diagnostic imaging
  • Pain / surgery
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • Treatment Outcome
  • Ultrasonography
  • Young Adult