What initial investigations should be considered for a patient presenting with a suspected abdominal wall hernia?

For a patient presenting with a suspected abdominal wall hernia, the initial investigations primarily involve a thorough clinical examination to confirm the diagnosis and assess the hernia's characteristics. Imaging is not always required but can be considered if the diagnosis is uncertain or to evaluate complications.

Ultrasound scan is often the first-line imaging modality as it is non-invasive, widely available, and effective in visualising abdominal wall defects and hernia contents.

CT scan may be used if ultrasound is inconclusive or if there is suspicion of complications such as bowel obstruction or strangulation, providing detailed anatomical information.

In cases where an abdominal aortic aneurysm (AAA) is suspected concurrently or as a differential diagnosis, an aortic ultrasound should be offered to exclude AAA, especially in patients with risk factors or palpable abdominal masses.

Further investigations such as MRI or laparoscopy are generally reserved for complex cases or when mesh-related complications are suspected post-hernia repair.