Possible recurrent femoral/inguinal hernia for female

[Judidah]

Last year I had laprascopic femoral and inguinal repair with mesh. At the time, I could feel the internal bulge but nothing could be felt externally by the dr. I had all the classic symptoms and finally a dr agreed to check laprascopically for a hernia. After the surgery and an inguinal and femoral hernia was fixed, I was fine for about 2 weeks or so and the pain and internal bulge feeling was back and has continually worsened. The hernia dr said surgery sight was ok and everything’s fine. I’m still having pain and feel it’s the hernia. I know it’s not right. My family dr did order an ultrasound and CT scan but nothing showed up so they feel it’s ok. My argument is that nothing showed up on those tests last year either and I had both femoral and inguinal. I’m very frustrated. The insurance company denied a MRI. Not sure what to do next…..if I can’t get an MRI, would you be able to diagnose with the ultrasound and CT in an online consult?

[Judidah]

Possible recurrent femoral/inguinal hernia for female

I’m also wondering if problems from the previous hernia surgery could account for a higher crp level. (1.28)

[Chaunce1234]

Possible recurrent femoral/inguinal hernia for female

A ct or ultrasound can miss a hernia as you are aware, especially if they were not done while you were bearing down and/or pushing (increasing abdominal pressure, known as a Valsalva maneuver). It’s possible that the hernia had nothing to do with the pain in the first place. It’s also possible the hernia is back, but unlikely. Sometimes, the only way to diagnose the problem is with another operation, but this should generally be the last resort. I would get an MRI, specifically looking for recurrent hernia, but also looking for surrounding musculoskeletal problems such as adductor, rectus muscle, psoas muscles, inflammations, along with hip or back problems. The test is non-invasive, and has no radiation. You’re primary should push for insurance approval for this.

[drtowfigh]

Possible recurrent femoral/inguinal hernia for female

It’s possible that your CT dies in fact show the problem and it is misread, but after a hernia repair, the CT is a poor study to evaluate the groin and pelvis. The mesh does not look much different than the muscle adjacent to it on CT, but MRI is a much more sensitive study to evaluate your hernia and the pelvis.

I would ask that your physician request a peer-to-peer review of the authorization and not accept the insurance company’s denial. They go by a protocol and non-physicians are making these decisions. Once a physician speaks to a physician and explains your situation, the MRI should be approved. I have yet to have one denied for my patients. But it takes time for the doctor to get this done. You can also have your ordering physician quote or send my manuscript that described in detail how MRIs are superior to CT for detection of small hernias. In my study, 10 0f 11 negative CT scans were positive on MRI.

To help you best, I would need an MRI to read.

[drtowfigh]

Possible recurrent femoral/inguinal hernia for female

Here is the link to the article on imaging standards for small hernias (and women).

http://www.ncbi.nlm.nih.gov/pubmed/25141884

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