Could this be a hernia???

[pszotek]

Could this be a hernia???

Thanks for the quick reply Sharon. Based on your history I am assuming they left the ovaries and you are not on hormone replacement therapy.

Here is a basic framework to break down groin pain/thigh pain/ right lower abdomen pain:

1) Hernia – for the most part one of the studies you had should have at least shown some bulging with valsalva if there was a weakness in the posterior layer which could then be stretching the nerve and causing pain. Also a femoral hernia can be present or even some pressure from some retroperitoneal tissue in that area but these two things were not present on your studies so we will assume they are not the cause. Also had you had a low transverse incision this could have been a cause. One other question that arises is: Do you have a scar in that general area from previous port placement for your laparoscopic surgery?

2) Intestines/Colon/Appendix:
– Constipation can cause some RLQ pain but unlikely the cause as you describe.

– Did they take your Appendix with any of your surgeries?

– Scar tissue from previous surgery pulling on your intestines.

3) Back/Spine:
– if the pain feels like it is wrapping all the way around from posterior then sometimes it is. I have had several patients go through the entire work up like you have and ultimately it was related to an impinging nerve at the spinal level. Did they look at spine on your MRI? Sometimes they have to do a special MRI. You mentioned some back problems. If the nerve is impinging at the level of the spinal cord this can cause what is called referred pain to the level of the groin.

4) Hip/Adductor tear
– there are a variety of Orthopaedic issues that can cause pain in this area from tearing of the rectus insertion point at the pubic/tearing of the adductor muscle/labrum tears. These should have been visualized on MRI if they were present but I want to mention because it seems things are worse being on your feet for long periods of time.

5) Gynecological:
– residual endometriosis can cause something similar and is partly why I asked. It does not fit the picture completely but is possible.
– rare occasion you can get some endometriosis at an old port site and partly why I asked if u have a scar from pervious surgery.

– if ovaries still present should be assessed by Gyn as could be causing pain.

– round ligament pain: this may be a consideration in your case. The round ligament exits the internal ring and then heads towards the pubic bone. It was cut somewhere along the line in your surgery but could be scarred to your bladder or in the area there. If the MRI is showing that your bladder is “dropped” on one side then the possibility exists that this is causing pressure/pain. Just a thought.

Overall it is really hard to speculate without seeing the images and examining you. I am sure that one of us would be happy to either see you or find a highly trusted and skilled colleague in your area to see you in the office if you wish. I am sure that I may have missed something as I am working on my iPhone so please ask questions if there are other thoughts you might have or discrepancies in my response. I hope this is a nice framework for you to uses as you continue to work through this problem. Thanks again and let me know if I can be of assistance. Paul Szotek