Analysis of Doppler-Based Perfusion Parameters and Development of a Composite Scoring System for Early Detection of Strangulated Hernia

Abstract

Strangulated hernia is a surgical emergency and if not diagnosed soon enough can become a life-threatening event if left untreated causing the bowel to become ischemic and necrotic. The clinical examination of a flexor flexure often is not sensitive for early vascular compromise. This study was conducted to assess Doppler ultrasonography parameters and to create a composite score in order to make early diagnosis of strangulated hernia. A hospital-based prospective observational study was designed to assess the outcome in 50 patients attending the hospital during three-month period with a diagnosis of abdominal wall hernias in a tertiary care hospital. Doppler indices such as resistive index (RI), peak systolic velocity (PSV), bowel wall thickness, and Doppler flow pattern was measured. Descriptive statistics, comparative tests, correlation analyses, ROC and multivariate logistic regression were used for statistical analysis. In 32%, it was confirmed that the cause of death was strangulation. RI was significantly higher (0.90 ± 0.03 vs 0.68 ± 0.02, p < 0.001) and PSV lower (10.5 ± 1.5 vs 20.5 ± 1.2 cm/s, p < 0.001) in strangulated hernias. The composite scoring system incorporating RI, PSV, bowel wall thickness, flow pattern and free fluid performed very well (AUC of 0.97, sensitivity and specificity of 94% and 90% respectively). These results have proven Doppler ultrasonography with a structured scoring system is an objective and very accurate method for early diagnosis of strangulated hernia, which is thought to improve the clinical outcomes (Hsu et al., 2020; Wu et al., 2021; Tanaka et al., 2021).