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Gastroenterology and hepatology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Groin mass:1 Hernia (inguinal; femoral; strangulated).2 Lymph node (infective or malignant enlargement).3 Cold abscess (of psoas sheath).4 Arterial (femoral artery aneurysm).5 Venous (saphena varix – dilatation of the long saphenous vein in the groin).
De Garengeot hernias. Over a century of experience. A systematic review of the literature and presentation of two cases
Published in Acta Chirurgica Belgica, 2022
Michail Chatzikonstantinou, Mohamed Toeima, Tao Ding, Almas Qazi, Niall Aston
The majority of the cases studied were patients who presented as an emergency. Although there were a few cases where the finding was incidental during an elective procedure [16,17], patients generally presented with a short history typical for femoral hernia. A painful, irreducible lump in the groin was the cardinal finding. Short history with local inflammatory signs, such as skin erythema or abscess formation and systemic symptoms, high temperature and biochemical markers, must raise the suspicion of hernia strangulation. Most of the included patients in this study had either a CT or and USS, or both. However, the gold standard for hernia diagnosis is still history and clinical examination of the groin. The differential diagnosis should include palpable lymph nodes, saphena varix or even an ectopic testis in male patients. In cases where the diagnosis is uncertain such as, groin swelling of unclear origin, vague clinical symptoms or difficult cases like small hernias in obese patients, further diagnostic investigation is required [18]. Ultrasound is generally cost-effective, well-tolerated, delivers no ionising radiation and, as initial diagnostic modality, shows high sensitivity [19]. However, it is operator dependant and is not always available out of hours. CT, on the other hand, has great specificity and sensitivity in diagnosing acute abdominal pain and establishing a diagnosis. It has a range of 86.7 to 96% for specificity and 80.7 to 92% for sensitivity in detecting acute appendicitis [20,21]. It is generally widely and quickly available and is not operator dependant; however, it requires the administration of intravenous contrast and delivers ionising radiation. A correct preoperative CT diagnosis of acute appendicitis within the femoral hernia was found to be only 68%, whereas the number for diagnosing De Gangrenot’s hernia with a USS fell to 5.5% [6]. No randomised controlled trial, systematic review or meta-analyses have been conducted to examine which diagnostic imaging modality is superior and more appropriate in detection of strangulated groin hernias in adults [18].