The Value of Contrast-Enhanced Ultrasound (CEUS) in the Detection of Perfusion Disturbances in Abdominal Wall Hernias Compared with Surgical and Histological Assessment.

Ehsan Safai Zadeh,Andreas Kirschbaum,Fiona Rodepeter,Marvin Görg,Christina Carolin Westhoff,Amjad Alhyari,Christian Görg,Christoph Frank Dietrich,Phillip Kuttkat,Corinna Trenker

doi:10.3390/diagnostics12020370

Abstract

Purpose: This study aimed to evaluate the value of contrast-enhanced ultrasound (CEUS) in the evaluation of perfusion disturbance in irreducible abdominal wall hernias (AWHs). Methods: From 2006 to 2018, 50 patients with an irreducible AWH were examined using B-mode ultrasound (B-US) and CEUS. The ultrasound findings were correlated with subsequent surgical and histological results. The presence of non-enhanced areas (NEAs) in hernia contents on CEUS and the presence of non-perfused areas (NPAs) on surgical and histological evaluation were analyzed retrospectively. Results: On CEUS, 13/50 hernia contents (26.0%) revealed NEAs during complete CEUS examination and 37/50 (74.0%) revealed no NEAs during CEUS examination. On surgical and histological evaluation, NPAs in hernia contents were identified in 11/13 cases (93.3%) with NEAs on CEUS. CEUS was found to have a sensitivity of 100.0%, a specificity of 94.9%, a positive predictive value of 84.6%, and a negative predictive value of 100.0% for the identification of perfusion disturbance in AWHs. Conclusions: The findings of this study demonstrate that using CEUS as an imaging method may be helpful for evaluating the perfusion of hernia contents in incarcerated AWHs. On CEUS, the presence of NEAs may suggest perfusion disturbance in hernia contents.

Highlights

contrast-enhanced ultrasound (CEUS) was found to have a sensitivity of 100.0%, a specificity of 94.9%, a positive predictive value of 84.6%, and a negative predictive value of 100.0% for the identification of perfusion disturbance in the abdominal wall hernias (AWHs) contents
In a standardized and surgically controlled study, we investigated the diagnostic accuracy of B-mode ultrasound (B-US) for the evaluation of the hernia contents and the diagnostic accuracy of CEUS in the detection of perfusion disturbance in the hernia contents of 50 patients with an irreducible AWH
The findings of this study demonstrate that the presence of non-enhanced areas (NEAs) on CEUS may be suggestive of perfusion disturbance

Summary

Introduction

It is estimated that more than 20 million hernias are operated on worldwide each year [4]. Surgical correction is elective in most patients, approximately 5.0–13.0% of patients require emergency surgery due to a strangulated AWH with blood flow disturbance in the hernia contents (omentum or bowel) [5]. Emergency cases are associated with high morbidity ranging from 19% to 30% (e.g., pulmonary and cardiac complications, anastomotic leakage and ileus, and wound infections) and high early mortality (within 30 days after an operation or before discharge from the hospital) ranging from 1.6% to 19.4% [6]. The early detection of perfusion disturbance due to a strangulated AWH may be beneficial for identifying patients who require urgent surgery and could improve the outcome of these patients [7]

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