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Hidden Internal Hernia? At My Wits End!
Dr. Towfigh,
I am a 32 year old female RN from NH. Below are a list of surgeries I have had:
10/24/12 – Gastric Bypass
1/17/13 – cholecystectomy
5/2014 – Exploratory Lap for left sided abdominal pain(looking for internal hernia)
1/20/15 – Paniculectomy
6/17/15 – repaired a mesenteric tear that had fat poking through it by suturing tear and placing meshI started having left sided abdominal pain in February of 2014. I would feel something pop out of my abdomen with straining and would be in extreme pain(to the point of screaming). I had one CT scan and the exploratory lap. I was then shoved off to pain management for almost a year. The pain/popping out continued the entire time. I have to reduce whatever pops out myself. In April of 2015, I stopped going to pain management because I was fed up with masking the problem. That same month my surgeon referred me to a physiatrist who found the mesenteric tear.
On June 17th, 2015 I went in and had the tear sutured and mesh placed. On Thursday, June 2nd, I sneezed and felt something pop out in my abdomen again. This time it felt a lot worse and each subsequent time it pops out, I have to work harder to push it back in. I reached out to my surgeon who is seeing me Monday and to the physiatrist who found that the mesh had acordioned and crated a space underneath it. He stated the the superior medial tack had failed. I also have two seromas. He has also informed me that my abdominal muscle wall is extremely thin and weak.
Since then, something has popped out underneath my belly button, on the left of my belly button where I’ve had the issues, and right and to the right of my belly button. I have to work hard to reduce it but can’t really feel a lump. Yesterday, it popped out 4-5 times, I had nausea, vomited once, so I went to the ED. The physician who was on set me up to perform another cat scan. My abdomen was distended to the point that my belly button was sticking out. He talked to my surgeon and came back and informed me that a CT scan was not necessary. I pushed hard to try to get one and he flat out refused. He took the advice of my surgeon who hadn’t examined me, had not see nor spoke to me in two weeks, and had no idea of what was going on.
Today, I sneezed and felt something pop out in my right side. I’ve coughed violently several times and it pops out in my left side where the original problem has been. It seems I can recreate the problem at home at times but when I goto the doctors, I can’t seem to repeat the same issue. Its like it has a mind of its own. They won’t do anything unless they can physically visualize it on some type of diagnostic test.
I don’t know what to do anymore. I am an RN and can not work because I can’t lift patients. Nursing is a very physical job. I have a few questions.
If this was a small internal hernia that was reducible, would it be possible for them to miss it on a CT scan?
The mesh lifted away from my abdomen but she sutured the tear, would it be possible for something to herniate out from underneath that?
Would an MRI be beneficial? Should I have another CT scan?
What I want done now is for her to replace the mesh, ensure the sutures are in place and to do an exploratory lap to make sure there are no other weaknesses. I requested an Exp. Lap. when she fixed the tear and she said it wasn’t necessary.
What are you recommendations? I am at a loss and completely struggling over here. I know there is at least if not 2-3 hernias. Here is a picture of the mesh from the ultrasound. Also are two other images he took which I am guessing are the two seromas?
Thank you so much,
Jamie
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3 Replies
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Hidden Internal Hernia? At My Wits End!
Have you had any progress or treatment since your last post? I worried about the symptoms you are describing.
A couple of things:
– Sounds like you never had an internal hernia in the past, just an abdominal wall hernia, which was repaired with mesh. Is that correct? Or did you have both?
– the ultrasound shows bulging of the mesh but the mesh looks intact, ie, nothing is coming through the mesh. You can feel a bulge from this, but it may or may not be a true hernia. A hernia is a hole through which things (fat, intestine) can go through.
– why are you coughing violently? This is putting your hernia repair at risk of failure, pulling apart.
– why are you vomiting? Is it due to an obstruction? Did the CT scan show anything abnormal? A swirling sign is not normal. It is suggestive of an internal hernia through a hole in between intestinal layers or mesentery this can occur with any prior operation as well as with gastric bypass.
– just because there is no bowel within your hernia does not mean it cannot be diagnosed on CT. The fascism defect can still be seen if that is the case. However, my greater concern is a possible internal hernia, which is very dangerous if not addressed properly, especially if it is causing your vomiting.If you wish, send me your films to review by mail and sign up for an online consultation with me so we can figure this out. I am concerned about this situation you are presenting.
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Hidden Internal Hernia? At My Wits End!
Dr. Towfigh,
I am absolutely desperate for your advice! I ended up in the ER after vomiting for four hours. They still couldn’t visualize a defect or hernia on U/S, BUT I KNOW ITS THERE! HOW do I PROCEED! 🙁 O
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Hidden Internal Hernia? At My Wits End!
I spent 14 hours at Umass General where I had CT Scan done that showed swirling. I had a repeat scan yesterday at a local hospital because I had vomited from 8p-12am. I’ve been told by my surgeon and the hernia specialist that my only hope now is to catch it on a musculoskeletal ultrasound. It is just getting it to pop out for him. 🙁
If I pop it out, could it cause the area around it to swell making it more of a challenge to pop out? If it was an internal hernia, can it be reduced and not visualized?
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