Hernia or Psoas?

[Retained ForeignBodies causing pain or Chronic pain from Hernia?]

Hernia or Psoas?

Hello Doctors,

I have an update: As I happened to be visiting Montreal in November, I took Dr. Earle’s recommendation, and arranged an appointment with Dr. Vassiliou. I explained my history and symptoms and gave her a copy of the ultrasound report which reads as follows:

“A very small left inguinal hernia located just lateral to the inferior epigastric artery. It contains only fat. It does not reduce completely at rest or with lying down. It increases slightly with Valsalva. The neck measures approximately 6mm”

There was no physical exam. She recommended I get the hernia fixed and that, if I didn’t mind traveling, she would be happy to perform the surgery (laparoscopically, with mesh) in the next few months.

Just last week I met with a local general surgeon (I am based in Calgary). In her opinion, a 6mm hernia is “insignificant” and barely bigger than the naturally occurring opening in that area. She explained that unless there is tissue further in the canal and creating a bulge, she would not recommend surgery. I asked about ‘hidden hernias’ and she did not seem to be aware of the concept.

Furthermore, she is not convinced that my symptoms are due to this hernia. She performed a physical exam and thought the area I indicated as most tender (just left of pubic bone) was a little low for an inguinal hernia. (It should be noted that when I had the ultrasound, the technician said it was femoral – I was surprised when the radiology report said inguinal). Also, when I mentioned that the pain at times extends up to the hip and wraps around to the back, she did not feel this was consistent with hernia. Her guess is that it is a pinched nerve or something musculoskeletal.

Also, in her opinion, patients who go into surgery with pain are more likely to have continued pain post-surgery. Her guess as to why is that the pain was not due to the hernia in the first place. (I am wondering if this is why the Shouldice Clinic won’t touch patients unless their hernias are palpable?)

This doctor suggests doing nothing except possibly acupuncture which might help if it is nerve pain. If or when the hernia gets bigger and detectable, she would then recommend I revisit the possibility of surgery.

Though I am not eager to have surgery and am willing to take a wait and see approach, I am dismayed at the notion that the hernia does not explain my pain! I feel intuitively that it IS the cause but know this could be wishful thinking. Needless to say, the second surgeon casts enough doubt that I am wary to go ahead with Dr. Vassiliou.

Does anyone have any thoughts or recommendations? Should I seek a third opinion? Wait and see? Thank you!