Reply To: Relationship between groin pain & foot / leg pain

[jeanvic]

Hello Dr Towfigh,

from the journal Hernia a review of the accuracy of CT to diagnose groin hernias (inguinal and femoral). The very last paragraph is from my doctor to me.

Best, Jeanie

JOURNAL ARTICLE
Computed tomography scan diagnosis of occult groin hernia
J F W Garvey
Hernia: the Journal of Hernias and Abdominal Wall Surgery 2012, 16 (3): 307-14
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22167621
BACKGROUND: The value of computed tomography (CT) for the diagnosis of clinically occult (hidden) groin hernia was assessed in a series of patients presenting with undiagnosed groin pain.
METHODS: A total of 158 consecutive patients presenting over a period of 5 years with undiagnosed groin pain or lower abdominal pain and negative or equivocal clinical findings were radiologically assessed with non-contrast CT. The decision to manage operatively or conservatively was then based on a combination of the clinical and CT findings. Outcomes were assessed at 10 years follow-up.
RESULTS: The study cohort comprised 158 patients presenting with groin or lower abdominal pain and/or swelling, and was studied prospectively. Seven of these patients were re-investigated at a later date after developing new pain on either the ipsilateral or contralateral side, giving a total of 165 CT examinations. One-third of cases (54) had clinically occult groin hernias and most of the remaining cases had diagnoses that could be managed non-operatively. Of those who came to surgery, the pre-operative CT diagnosis of hernia had a positive predictive value (PPV) of 92% and a negative predictive value (NPV) of 96% (overall accuracy 94%). Lipoma of the spermatic cord was responsible for three of five false-positive CT results. The concept of sports hernia/groin disruption injury (GDI) was encountered, and this entity is discussed in this paper. In the group of patients without hernia findings on CT, the most common diagnoses were rectus abdominis and/or pyramidalis muscle injury which could be treated by physiotherapy (22%), GDI (16%), post-surgical problems (14%), miscellaneous (20%) and ‘no abnormality’ was identified in 15%. Overall, there were 111 patients with a ‘non-hernia’ CT diagnosis, of which urological, gynaecological, gastrointestinal and neuralgia contributed to the non-musculoskeletal diagnosis.
CONCLUSION: This prospective non-contrast CT study of patients with undiagnosed chronic groin pain detected the majority of occult hernias requiring surgical intervention. These results suggest that CT can be a useful adjunct to the evaluation of patients presenting with chronic undiagnosed groin pain, but that experienced clinical judgment remains a critical element in the diagnostic pathway.
Based on this large series— CT scan had a negative predictive value of 96%– meaning if the CT is negative there is a 96% that you truly do not have a hernia- which does leave a 4% or 1 in 25 chance there is a hernia.

So I would say complete the other evaluations and then we can talk. I could perform a diagnostic laparoscopy but as I said I think the chance of finding something in < 10% while this article with a large number of patients would say in the face of a negative CT for a hernia the chance of me finding a hernia as a cause of your pain is 4% (meaning the CT would be wrong). Now a 1 in 25 chance is not good but again even a negative laparoscopy may be helpful going forward as at least you would know that there is no intra-abdominal pathology to explain your pain.