Objectives: Symptomatic groin hernias in women may be difficult to assess clinically and commonly mimic pathologic musculoskeletal and gynecologic conditions. The objective of our study was to investigate the accuracy of sonography in women with groin pain and normal physical examination findings.
Methods: A consecutive group of 87 women (median age, 44.6 years; range, 19-82 years) with groin pain and normal physical examination findings were included in the study. All patients had a standardized sonographic examination of the groin performed by an experienced radiologist or a sonographer. If a groin hernia was identified, it was classified as indirect, direct, or femoral. Normal examination findings and alternate pathologic groin conditions were also recorded. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the sonographic findings and compared to the findings for patients sent for surgery.
Results: Of the 87 women with groin pain, 37 groin hernias were diagnosed in 35 patients. Surgery was performed in 26 patients (27 groins). Sonography correctly depicted and classified groin hernias in 18 of the 21 groins that had surgical confirmation. Six women without groin hernias also had surgical exploration of the affected side. The sensitivity, specificity, positive predictive value, and negative predictive value for the patients with surgical confirmation were 95%, 75%, 95%, and 75%, respectively. Groin pain in 26 patients was attributed to other causes. The remainder of the patients had normal examination findings or were lost to follow-up.
Conclusions: Groin hernias in women can be occult and confound the clinical diagnosis. In a woman with groin pain and normal or indeterminate physical examination findings, we have found that sonography can accurately depict and classify groin hernias and other pathologic processes.