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CT scan or physical exam: which is a better diagnostic tool for incarcerated hernia?
Mbaga Walusimbi1, Ronald J. Markert1, Safoora Choudry*2,1
1Surgery, Wright State University, Dayton, OH; 2Surgery, Southern Illinois University, Springifield, IL
Objective:
This study asks how reliable is the CT scan in diagnosing incarcerated hernias, ischemia, and small bowel obstruction in relation to the physical exam.
Background:
Historically the diagnosis of incarcerated hernia has been clinical relying primarily on the physical exam. With the advent of imaging technology, particularly the multi-detector CT scan, the diagnosis of emergent operative conditions has shifted from that of the physical exam to one of increasing reliance on imaging. It is unknown how accurate CT scan in diagnosing incarcerated hernia, small intestinal obstruction or strangulation. This shift, however, may lead to false positive and patients consequently may be subjected to unnecessary operative interventions and its complications; or may lead to delay in surgical intervention because of false negative findings.
Methods:
Patient data was extracted from post-operative notes, radiologic CT impressions, and
physical exam notes by surgeryteam at time of admission. Additionally, demographic data was collected from patient charts. 40 patients were selected admitted to MVH between 2007-2013.
Results:
Results showed that CT scan as a diagnostic tool for incarcerated hernia, ischemic bowel, and small bowel obstruction had a sensitivity of 55.6%, 33.3%, and 85.7% respectively, and specificity of 73.7%, 97.1%, and 74.2% respectively. Physical exam as a diagnostic
tool for incarceration had a sensitivity of 63.2% and specificity of 93.8%.
Conclusion:
Our data demonstrates three basic conclusions. First, physical exam is still more sensitive and specific in diagnosis of incarcerated hernias. Second, CT scan is particularly reliable or sensitive in diagnosis of small bowel obstruction, and third, specific for ischemic bowel
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