The pubic tubercle: a CT landmark in groin hernia

Area of Science:

• Radiology
• Surgical Anatomy
• Medical Imaging

Background:

• Groin hernias are common surgical conditions requiring accurate pre-operative diagnosis.
• Distinguishing between inguinal and femoral hernias is crucial for surgical planning and patient outcomes.
• Computed tomography (CT) is a valuable imaging modality for evaluating abdominal pathologies.

Purpose of the Study:

• To evaluate the pubic tubercle as a consistent anatomical landmark on CT scans for classifying groin hernias.
• To correlate CT findings with surgical diagnoses for inguinal and femoral hernias.
• To assess the reliability of CT in differentiating direct inguinal, indirect inguinal, and femoral hernias.

Main Methods:

• Retrospective review of CT scans from 42 patients with surgically confirmed groin hernias.
• Analysis of hernia location relative to the pubic tubercle using a coordinate system.
• Assessment of hernia position in relation to the inferior epigastric artery.
• Comparison of CT-based classification with surgical findings.

Main Results:

• The pubic tubercle-centered coordinate system effectively differentiated hernia types: inguinal hernias were ventral to the X-axis, and femoral hernias were dorsal.
• Direct inguinal hernias were located lateral to the Y-axis, while indirect inguinal hernias crossed the Y-axis medially.
• The inferior epigastric artery was visualized in 90% of cases, with CT findings consistent with surgical reports.
• The CT classification showed high concordance with surgical findings for all hernia types (50% indirect inguinal, 31% direct inguinal, 19% femoral).

Conclusions:

• The pubic tubercle is a reliable CT landmark for distinguishing between inguinal and femoral hernias.
• CT imaging, utilizing the pubic tubercle as a reference, provides accurate pre-operative classification of groin hernias.
• This CT-based anatomical approach enhances diagnostic accuracy and supports surgical planning for groin hernia repair.