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Direct Inguinal Hernia Pain
Hello,
I’m a 32 year old male in the healthcare field who began experiencing left groin pain in Aug 2019 from around the spermatic cord (where it exits the inguinal canal) down to the epididymis. Feels like a tense/taut spermatic cord. I get uncomfortableness whenever I sit or lie down. Standing relieves the discomfort quite a bit.
Surgical history wise, i had an open-ended vasectomy in Nov 2018, with no post-op issues for the 10 months until my groin pain began.
I recently had an ultrasound that revealed a direct inguinal hernia measuring 2.3×1.3×1.7cm with anterior wall defect of 6mm. The hernia is not reducible, and contains primarily omentum. No issues noted with the testies, epididymis. No evidence of hydrocele or varicocele.
Prior to the ultrasound, the physician and specialist were leaning towards post-vasectomy pain as being behind my condition. The hernia isn’t noticable clinically.
My question is, with this ultrasound finding, what is the likelihood that a direct inguinal hernia of this size could be symptomatic? What is the best way to differentiate the source of this pain prior to surgery? My concern would be going under the knife to correct the hernia, only to find out it was asymptomatic and be left at the same point.
Thanks to anyone who reads my case and provides me with insight,
A Fellow Healthcare Worker -
7 Replies
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@ontarioanswers
Dear Ontario.
The next step would be to see a general surgeon and discuss the options for repair.
Regards.
Bill Brown MD -
@ontarioanswers
Dear Ontario.
Did the ultrasound identify if your hernia was direct or indirect.
Indirect hernias are more likely to cause spermatic cord pain.
If you are skinny, then the surgeon should be able to palpate the hernia.
Regards.
Bill Brown MD -
@ontarioanswers
A careful history and physical examination is the next step. A thoughtful surgeon should be able to differentiate between a hernia and spermatic cord pain.
Also, Consider diagnostic injections. For example, if the spermatic cord is injected with a local anesthetic and you feel better for a few hours, then the cord is probably the source of your pain. In a similar manner, other structures can be injected with a local anesthetic.
Regards.
BIll Brown MD -
You are in a difficult spot for finding good information. If you read through the posts on the site you’ll see how healthcare has moved almost completely to mesh implantation for hernia repair, even doing repairs for asymptomatic hernias, under the premise that potential strangulation is a risk, and that mesh is completely safe and almost foolproof.
The best thing that you could do at this point is to read as many of the posts on this forum as you can. It’s all been described here, and there is no easy answer. Today, “specialist” just means that they focus on one thing. It does not mean that they are experts.
Good luck.
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I would have thought with an hernia lying down would reduce the pain, nor the other way around…
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Thank you for your followup, Dr. Brown.
Ultrasound identified “direct inguinal hernia measuring 2.3×1.3×1.7cm with anterior wall defect of 6mm. The hernia is not reducible, and contains primarily omentum. No issues noted with the testies, epididymis. No evidence of hydrocele or varicocele.”
I am rather skinny, 6’1″, 180 pds. My general prac, urologist, have not been able to feel the hernia clinically, though examinations have been relatively brief ~10 secs. On my own thorough self-examination, I feel small lump underneath the spermatic cord right where it enters the inguinal canal, thats quite tender to palpation and feels like the central source of my daily discomfort when sitting.
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Thanks for the insight, Dr. Brown.
In your clinical experience, do you see instances where abdominal tissue pushes through a hernial opening and compresses on a spermatic cord resulting in the cord being tender or irritated? In these cases, has hernial repair resolved the pain?
Should a 2.3cm × 1.3cm x 1.7cm hernia noted on an ultrasound be easy to identify clinically? If the hernia can’t be detected clinically, should what was seen on the ultrasound be re-evaluated?
Thanks for your time,
OA
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