Could this be a hernia???

[pszotek]

Could this be a hernia???

Great to hear you are making some progress and something was identified. Although you are correct that many folks complain about pain on the left it can really be located on either side. Hopefully the antibiotics clear it up. Appreciate the follow up and let us know hoe you are doing.

[buster]

Could this be a hernia???

Thank you all for your input. I had my barium enema test today and the doctor said I had diverticulosis and put me on an antibiotic and told me to continue clear diet. Do you think this is it? I always thought most diverticulitis happens on left. I see my gyn next week. I guess wait and see how things go and if no better I will check back in and either consultation online or take your advise and make the trip to Saint Augustine.
still in a lot of pain can’t do anything and I’m not working till I figure this out.

[pszotek]

Could this be a hernia???

Thanks for replying. Let me try to systematically answer your questions.

1) I have never heard of endometriosis being visualized on CT or Ultrasound and to my knowledge I would agree w/ Dr. Earle.

2) A herniated disc could indeed be causing referred pain like this. Another example to think about is left arm pain with a heart attack or right shoulder pain with gallbladder pain. These are all types of referred pain. The nerves are like guitar strings coming out of the spine and wrapping around to the front. A pinch of pressure anywhere along them can be transmitted along their length and cause referred pain. Although this may not be your case it can occur. Do you wear any kind of work belt?

3) enema – this is a good idea and your pain definitely could be related to diverticula but the duration and description do not seem to fit perfectly. I would have the test to confirm this though.

4) Gyn: I would see what the results of your tests are and inquire about possible causes as I mentioned earlier.

5) ultimately I suspect you will end up w/ diagnostic lap/TAPP Inguinal hernia repair like Dr. Earle suggested.

Hope that helps a bit.
Dr. Szotek

[DrEarle]

Could this be a hernia???

You can’t see endometriosis on any radiological test. IF your pain is cyclical, it is most likely endometriosis. Try Michael Hsu in St. Augustine. He’s a former fellow of mine, and a very good surgeon. It close enough to get a thorough opinion. Tell him I sent you. DE

[buster]

Could this be a hernia???

Thank you for your response as well. First let me say no other surgeries. As far as the port , no the pain is below that area. The pain is constant laying usually gives me relief. as far as endometriosis, wouldn’t that have been seen on ultra sound or ct scan? The back pain is from a herniated disc but I do not feel the back pain as this pain is so far worst.

I am going for a barium enema test on Thursday. Is there any suggestions to tell or ask dr while doing this. Would they see a hernia if one is there? The reason I’m having this test is they couldn’t get through during colonoscopy due to diverticulosis.

Next week I am seeing the gynecologist. If nothing found in the barium test, any questions I should ask?

If nothing found on either test I am going to either see a specialist that you all could possibly recomend or do the online consultation.

Also, a friend of mind who told me about this site (Aminuts) had multiple test 2 ultra sounds one with valsalva, 3 ct scans with and without contrast(also one valsalva) small bowel follow thru, colonoscopy, and endoscopy all negative to hernia! She sent her test to Dr Towfigh’s online consultation who suspected right inguinal hernia possibly left inguinal hernia but test were not done correctly to see the area. She referred to Dr Ramshaw who was relocating to Tenn. but consulted with her and did an exam. He also suspected! She flew to Dr. Towfigh and had surgery that same week bilateral inguinal hernia and right femoral. She suspected left femoral as well but assuming once inside left was not there.

Sorry so long, but my point is all test negative and she had 3 hernias that took 2 1/2 years to diagnose. We live in same area and test from same company some were at a different facility.

My location is the southeast coast of Florida if you have any suggestions for a hernia specialist if needed!

Note i am preping today and tomorrow for the barium test and I am in even more pain and laying down only some relief. So maybe something with colon or intestine. She is helping me with answering questions so we will keep you posted.

Thank you for taking the time to help me and if any suggestions to above I am greatly appreciative.

[DrEarle]

Could this be a hernia???

Dr. Szotek’s post is excellent. If your pain is cyclical, could be endometriosis. If not, lap inguinal hernia repair (in the absence of other findings to explain pain) would be expected to have about a 60-70% chance of some pain relief. The amount and duration of this relief are difficult to predict. It’s tough to find a surgeon to operate, however, without a firm diagnosis, but more are coming on board. Let me know where you live, and perhaps myself and the others can recommend someone for you to see. Hope this helps! DE

[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

[buster]

Could this be a hernia???

Thanks Dr. Szotek for your prompt response. To answer your question both surgeries laposcopy and was related to endometriosis.
Thank you
Sharon

[pszotek]

Could this be a hernia???

Sharon,

Sorry for all your pain. A couple clarifications I would like to make prior to entertaining your question more fully is what incision did you have for your hysterectomy and FT work? Midline? Low Transverse (bikini line)? Laparoscopic?

Why did you have hysterectomy?

History of Endometriosis, etc?

Thanks. Dr. Szotek

[buster]

Could this be a hernia???

New at computers, sorry I didn’t notice was to large so I am just giving the impression. Thank you again