Kasık Fıtıklarında Preoperatif Radyolojik Değerlendirme
Özet
Kasık fıtıkları, abdominal hernilerin yaklaşık %75’ini oluşturan ve sıklıkla klinik muayene ile tanı alan yaygın bir hastalık grubudur. Ancak okkült (gizli), küçük veya obez hastalardaki fıtıkların teşhisinde ve cerrahi yaklaşımı belirlemede preoperatif radyolojik görüntüleme kritik öneme sahiptir. İnguinal herniler en sık görülen alt tip olup anatomik olarak direkt ve indirekt olarak ikiye ayrılır. Ultrason (US), noninvaziv, hızlı ve Valsalva manevrasıyla dinamik inceleme imkanı sunması nedeniyle ilk tercih edilen modalitedir; ancak kullanıcı bağımlı olması okkült hernilerde duyarlılığını düşürebilir. Bilgisayarlı tomografi (BT), yüksek anatomik çözünürlüğü ve "lateral hilal bulgusu" gibi spesifik kriterleri ile direkt-indirekt ayrımında ve özellikle strangülasyon gibi acil komplikasyon şüphelerinde hızlı yapısı nedeniyle öne çıkar. Manyetik rezonans görüntüleme (MRG), yüksek yumuşak doku çözünürlüğü ile okkült hernilerde ve ayırıcı tanıda en yüksek duyarlılığı göstermesine rağmen maliyet ve ulaşılabilirlik nedeniyle ikinci plandadır. Femoral herniler ise inguinal ligamentin altında, femoral venin medialinde yer alan, kadınlarda daha sık görülen ve yüksek strangülasyon riski taşıyan nadir hernilerdir. Klinik muayenenin yetersiz kaldığı durumlarda US ve BT, femoral hernilerin doğru teşhisinde ve inguinal hernilerden ayırt edilmesinde yüksek başarı oranına sahiptir.
Groin hernias account for approximately 75% of abdominal hernias and are frequently diagnosed via clinical examination, but preoperative radiological imaging is critical for diagnosing occult, small, or obese patients' hernias and determining the surgical approach. Inguinal hernias are the most common subtype and are anatomically divided into direct and indirect. Ultrasound (US) is the first-choice modality due to being noninvasive, fast, and allowing dynamic evaluation with the Valsalva maneuver; however, being operator-dependent can lower its sensitivity in occult hernias. Computed tomography (CT) stands out in direct-indirect differentiation with its high anatomical resolution and specific criteria like the "lateral crescent sign," and is preferred primarily in cases with suspected acute complications such as strangulation due to its speed. Magnetic resonance imaging (MRI) provides the highest sensitivity in occult hernias and differential diagnosis owing to high soft-tissue resolution, but remains a second-line option due to cost and availability. Femoral hernias are rare hernias located below the inguinal ligament and medial to the femoral vein, which are more common in women and carry a high risk of strangulation. When clinical examination is insufficient, US and CT achieve high success rates in accurately diagnosing femoral hernias and differentiating them from inguinal hernias.
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