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MRI for possible occult hernia? Tissue repair still possible?
Hoping that @drtowfigh might respond (and curious if @drkang might have an opinion too). Also interested in the experience of others.
The short of it is that I wonder if I might have an occult/hidden hernia, given the symptoms and no bulge.
Me: late 40’s, slim build, no major physical health issues, and had two inguinal repairs done at Shouldice in Toronto…one side (left?) almost 30 years ago and the other side about 17 years ago. Zero post-op or long-term issues in both cases.
I think I badly overstretched my groin and abs about 4-5 weeks ago, but that general pain cleared up, with some tenderness remaining from hip bone and pubic bone on left side (inguinal ligament?).
For the past two weeks, I get the familiar intermittent tingling/burning sensation in left groin region depending upon sitting/laying position, which reminded me of pre-op hernia discomfort, but without any telltale bulge (no testicular pain).
Two days ago, it became more acutely painful and very tender to the touch just inside the crease between thigh and groin…maybe a very tiny bit of swelling, but no visible bulge. Symptoms remained overnight, so I went to a hospital (in Montreal) but ER doctors could find no evidence of new or recurrent hernia based on physical exam, ultrasound, and CT (not sure if CT was ordered for suspected hernia or just ‘groin pain’). They also took blood and urine to rule out some other things. Puzzled about the source of my pain, I was advised to take pain/inflammation meds and come back if it gets worse again (it had settled down while I was there and is now closer to where it was for the past couple of weeks). I am reluctant to ‘wait and see’,
1. Would MRI be an appropriate next step? If so, I wonder if Dr. Towfigh might repost the protocol she uses with her radiologists (the one in an old post is blurry and hard to read when enlarged).
2. If it is indeed an occult hernia, is an open tissue repair still possible? I’m very reluctant to consider a mesh repair of any kind, given the terrible experiences some have reported…but I think Shouldice will not do anything unless there is a palpable hernia?
Many thanks for this incredible resource and your expertise!
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8 Replies
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Mark T… If you do go to Shouldice Canada can you post how it be went… I am not sure anyone, anywhere has 100 percent positive though.
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I know when mum was being diagnosed for something, the NHS went from xray to CT ti mri to contrast imaging. Each time they said they were not sure, images not clear.
So I think a lot depends, as has been said, on who does them and who reads them how proficient and expert they are.
Additionally, Pinto had pointed out an ultrasound should be “valsalva” to be most effective – I’m not sure what that means.
Whilst someone else has said their hernia was missed on imaging until one surgeon got an ultrasound done whilst the person was standing up.
Best of luck.
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Odds are if you’ve been fine, and now you have problems you have a recurrence. It would just be nice to know that for sure or exhaust less invasive options before surgery.
And if the hernia does progress and enlarge as you said was your prior experience… You may develop a bulge or other signs that make the diagnosis more certain. But I sympathize with your desire to get things taken care of and get on with your life as quickly as possible. Has shouldice offered you surgery? Or is that 12 weeks just to get on the schedule to be seen?
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If it’s only been a few weeks I would give it some serious time to work itself out before rushing into surgery. At least several months. If you had a full work up in the emergency room with negative ultrasound and CT scan the likelihood that there’s an emergency there is low. Any variety of groin strain or sprain is possible and may take months to sort itself out. I know another hernia is anxiety provoking but you don’t need to rush into it.
An MRI does have the advantage of potentially showing other soft tissue injuries as well.
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I think I found the answers to both questions:
1. Yes, MRI is the next imaging step when ultrasound and CT are negative/inconclusive. Dr. Towfigh’s MRI protocol can be found at the 36:00 mark of the HerniaTalk 67 video from Aug. 17, 2021: https://www.youtube.com/watch?v=jJcu8kHPkgA.
2. Tissue repairs are possible for occult hernias. Other factors, such as body weight, tissue quality, etc., may still be relevant though.
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Hi William – I’ve actually been to Shouldice twice for inguinal hernia repairs. I had one side done 30yrs ago, the other about 18, I think. I really have nothing negative to report, as I had no post-op complications, no long term pain, and no impact on lifestyle/exercise/etc. ever since.
I have recommended Shouldice to many people over the years and I will almost certainly go back, if this does prove to be a hernia. I am clearly not an expert, but I have yet to see compelling arguments to NOT go with their repair (or some version of it), providing that it is determined to be a suitable option (I know going to Shouldice may be a less straightforward decision for non-Canadians).
btw, Valsalva maneuver can be found online…for the purposes here, it is kind of like straining for a bowel movement, which can help ID abdominal wall hernias during imaging. Dr. Towfigh mentions it in her HerniaTalk vid on imaging from Aug. 2021 that is on youtube and posted in another thread.
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12 weeks is their current wait time for surgery…you can walk-in for a consult same-day, depending on how busy they are. Without a palpable hernia, I’m pretty sure they do not operate…but wondering if they do if you have imaging evidence. You can submit a medical questionnaire on their site and a surgeon will review it, potentially asking for more info, so I may go that route to see if MRI would do it (again, assuming it does prove to be a hernia).
Hopefully it does not progress much and I can arrange an MRI at some point soon.
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Thanks, I appreciate your response. It is anxiety provoking for sure, though it was indeed a relief for the initial ER visit to reduce the likelihood of an emergency problem.
It has actually been about 8 weeks now and the symptoms, despite no palpable hernia, leave me pessimistic that it is ‘only’ a strain…although that would be a welcome diagnosis (relatively speaking)! At this point, I just want a definitive diagnosis either way, so I will try to get the MRI done soon.
I know some are ‘lucky’ and have had virtually pain-free hernias (even for years!), but my past experiences have been that it simply grew more and more uncomfortable in the short-term. Right now, it seems that Shouldice is booking ~12 weeks out, so I would rather not ‘wait and see’ for too long.
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