Asymptomatic contralateral inguinal and ventral hernias among people with a workers’ compensation claim for hernia - 12/11/21

Doi : 10.1016/j.jviscsurg.2021.09.008

T.J. Crijns ^a,^⁎ , A. Fatehi ^a, B. Coopwood ^a, D. Ring ^a, M. Tonn ^b
^a Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
^b Occupational Medicine & Pain Management, OccMD Group, Texas Health Dallas, Dallas, TX, USA

^⁎Corresponding author. Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building; MC Z0800, 1701 Trinity St., 78712 Austin, TX, USA.Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building; MC Z08001701 Trinity St.Austin, TX78712USA

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 12 November 2021
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Highlights

•	A notable proportion of people (35 out of 106, 33%) with a Workers’ Compensation claim for hernia have an incidental (asymptomatic) hernia elsewhere.
•	People who have a second, incidental hernia, are either less likely to be offered or less likely to choose surgery.
•	Our data support that hernia might be incidental to abdominal symptoms (e.g. muscle strain) but is unlikely to be caused by strenuous physical activity.
•	Population-based studies of the prevalence of incidental hernia by occupation and longitudinal studies of people starting heavy labor occupations can help determine if there is an association between heavy work and pathology of abdominal hernia.

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Summary

Study aim

There is a gap in evidence that demonstrates an increased risk of hernia formation in laborers. A notable incidence of a second asymptomatic hernia among people making a workers’ compensation claim for a hernia would suggest that the pathology is not acute and probably not related to work, or the performance of a single strenuous event.

Patients and methods

We performed a retrospective database study of a consecutive sample of 106 adults who claimed a work-related abdominal hernia between September 2016 and December 2018 and had a Computed Tomography (CT) scan as part of a diagnostic workup. Hernias were classified as incidental if patients had a contralateral inguinal hernia with unilateral groin symptoms, or if patients had a ventral hernia with only groin symptoms or vice versa.

Results

Thirty-three percent of patients had an incidental hernia. No patient factors were associated with having an incidental hernia. Higher BMI and having a concurrent incidental hernia were associated with lower odds of surgical treatment under the injury claim.

Conclusion

Abdominal symptoms after a work event might lead to a diagnosis of hernia, and there is a notable likelihood that the hernia is incidental and unrelated to work. New symptoms at or near the site of an abdominal hernia may or may not be from the hernia, and very often are more consistent with an abdominal muscle strain. The clinical or imaging finding of an abdominal wall defect or the presence of a hernia may be incidental, unrelated to the physical activity.

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Keywords : Abdominal hernia, Incidental findings, Contralateral, CT scan, Workers’ Compensation insurance