Color duplex sonography: diagnostic tool in the differentiation of inguinal hernias

We investigated the accuracy of combined physical and color duplex sonographic examination in the preoperative distinction of direct inguinal hernias. After a learning period (with 15 male patients) 50 consecutive male patients who underwent surgery in our department for small inguinal hernias between July 1995 and April 1996 were examined. On color duplex examination the relationship between the hernial sac and the inferior epigastric artery was determined. Intraoperative results were then compared with the data obtained preoperatively. The sensitivity of our physical examination for direct inguinal hernia was 75% with a specificity and a positive predictive value of 100% and a negative predictive value of 80%. The identification of the IEA as well as the hernial sac was successful on every color duplex sonographic study. The sensitivity of color duplex sonography for direct inguinal hernias amounted to 90%, the specificity was 86%, the positive predictive value was 78%, and the negative predictive value was 89%. Both combined hernias found intraoperatively had not been detected either by physical examination or by color duplex examination. Correspondence of results obtained by physical examination and color duplex examination leads to high accuracy in the diagnosis of direct inguinal hernias.