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  • Spigelian questions

    Posted by lifeboat00 on February 4, 2016 at 12:03 am

    I have read on here that if you have laproscopic surgery to explore for a hernia, that one can be missed if they don’t take down the peritoneum. Is this not routine for a surgeon to do this if they suspect a hernia?

    Can a small sliding inguinal hernia mimic a spegelian or a femoral hernia? Can this be interpreted wrong by the radiologist? Can spegelian hernias just contain abdomen fat?

    Can a right flank bulge be mistaken for a spegelian hernia?

    Can a very large flank hernia invade or affect your thigh? As in not being diagnosed in a timely manner.

    mapleleaf replied 8 years, 2 months ago 4 Members · 6 Replies
  • 6 Replies
  • drtowfigh

    March 5, 2016 at 7:52 pm

    Thank you Dr Goldstein and Dr Towfigh/hernia ??

    No specialists in North Dakota. I know because I’ve treated patients from that state and have had a hard time even getting followup care for them there.

    Minnesota: consider Dr Archana Ramaswamy. She’s very smart.

    I provide online consultations where I can review all your scans for you. I am concerned they may be misread. You can find this opportunity on my website

  • mapleleaf

    March 4, 2016 at 5:39 pm

    Thank you Dr Goldstein and Dr Towfigh/hernia ??

    Thank you for your input. I had difficulty logging back on to web site. Sorry for the delay.

    Dr Goldstein, my Gallbladder scar is 30+ years it was a mid-line incision.

    Yes Dr Towfigh, I can say that there was blunt trauma to my right side.

    Initially I thought it to be a pulled muscle. I could not lay on my right side for weeks. I did notice a small protrusion to the left of my right hip that would come and go.

    I have to say, that it was months later, that I developed some soft tissue swelling over the right trochanter. This would come and go with rest. At night I would get severe pain in my right thigh “Charlie horse”like. The pain is excruciating. I then developed a bulgy lump at top of thigh crease which has actually moved down into my right side of my thigh. Hence the “charlie horse pain” It is moveable as this is why they thought it to be femoral. To me, this lumpy stuff on the right side of my thigh does not belong there.

    Laying on my right side is very painful when I do endure the pain it feels like someone is pulling my insides of belly down towards my lower abdomen. I might add, that it will get pink and warm to touch on the lower right abdomen. It will go away after some time. I have had small bruising over the bulge where pant waist band sits but I tend to move waist band off the bulge. When I do lay on my left side lately it feels like something is pressing on my lower right ribs. It feels very full at the waist. Also in the morning I have large swelling over my right buttock. Sometime with deep breathing I have pain under my right ribs.

    There are no “hernia specialist” in my area. I feel that my doctors have given up on trying to find the source of my pain. The closest would be Minnesota or North Dakota as I am north of your border.

    Cost could be a factor for me but I am desperate to consult a “hernia specialist” to look at my scans and at the very least, rule out the possibility of a hernia.

    Thank you Dr Goldstein and Dr Towfigh for your expert advise on hernias. You have answered many of my unanswered questions. So glad I found this site.

  • drtowfigh

    February 9, 2016 at 5:28 am

    spegelian questions

    You are very correct in the lineage of your questions. If you feel a bulge, then it should be visible on CT scan, even without a bear down or valsalva. If the report is “negative,” then you need it to be re-read by a specialist.

    Flank hernias are either traumatic (e.g., bad car accident) or due to surgery, as Dr. Goldstein stated. But you are mentioning bulging at the groin crease and the hip, with symptoms that are more suggestive of an inguinal hernia.

    I recommend you see a specialist in hernias that can review your imaging, take your history into consideration, and perform a careful examination.

    Where do you live? We can refer you to someone local who we know and respect.

  • sngoldstein

    February 9, 2016 at 3:01 am

    spegelian questions

    Yes, that is a lot of questions. A true hernia is absence of the abdominal wall and unless it is very small will not be missed on a CT. Was your gallbladder done open? You may have a nerve injury from that surgery causing weakness of your abdominal muscles. You really need to see a surgeon who specializes in abdominal wall issues and have them examine you and review your CT images.

  • lifeboat00

    February 9, 2016 at 12:37 am

    spegelian questions

    Thank you Dr Goldstein for answering my questions.

    I have always maintained that I have some kind of abd hernia. Years ago I felt a pop on the right side of my belly.

    I developed severe right sided abdominal pain. I had Abdominal distention with swelling in the right flank. ER doctor Diagnosis was IBS.

    Seen by GI and ESD was negative. GI thought it could be an internal hernia.

    Seen by a surgeon who thought a flank hernia was conceivable given my symptoms (felt a small bulge over right hip bone when laying on right side this would come and go). CT scan was negative this diagnosis was dismissed.

    My abd pain on the right has increased. Any activity I do, I get increased abdominal distention. Pain on the right side over right hip and under right ribs.

    I developed a bulge below my right inguinal crease. GP thought it to be a femoral hernia. U/S showed a small sliding inguinal hernia. Seen by surgeon again which was dismissed by him. But due to my pain, and with some persuasion he agreed to a laparocopy. This turned out to be negative for inguinal, femoral or a obturator hernia.

    Since the Lap surgery, I have had increased pain on the right side of belly and the bulge over the right hip has increased. I now have an asymmetrical belly. I have swelling to my right thigh. When standing for a long period, I get sharp stabbing pain to the top of my thigh. I have pain in the right side when sitting. It feels very bulgy at the waist. When I bend at waist, I get sharp pinching pain over right hip. Embarrassing to say but when wiping self in bathroom I get severe muscle like cramping at right side. This is excruciating at times. When laying down I hear gurgling sounds in the fat! If I push on belly it will gurgle. Any activity with right arm increases my pain at the waist and under right ribs.

    MRI of pelvis shows infiltration in the right gluteal.

    Seen by a neurologist as the surgeon thought my swollen thigh to be parasthetica meralgia but the neurologist stated that I have no symptoms that relate to this.

    Seen by vascular surgeon which they thought something was pressing on large saphenous vein up in right hip area. (which is where I feel the bulge) But because CT was normal this was also dismissed.

    I am wondering if in-fact I have some kind of internal or flank hernia.

    I have an allergy to CT contrast and I have never had valsalva maneuvers done with a CT. Can a hernia be missed if these procedures are not done? In regards to the sliding hernia. Can this be a low lying spigelian hernia? Can a spigelian hernia containing abdominal fat be missed on a CT. I am over weight.
    If a flank hernia is so rare, How does one know what they are looking for? Can this be missed if they are not familiar with this kind of hernia? Can abdominal distention interfere with the CT scans? Can a incisional hernia via c-section scar mimic a femoral hernia? Would this have been seen on an abdominal CT scan? Hence the thigh bulge and swelling. I apologize for so many silly questions but I am lost for answers to the source of this right sided belly pain.

    I have had 2 previous abdominal surgeries prior to the laparoscopy. Gallbladder and C-section.

    Thank you in advance for helping me with my hernia questions.

  • sngoldstein

    February 7, 2016 at 1:18 am

    spegelian questions

    Yes, a small fat containing hernia could be missed on a laparoscopy, If it was that small, it would pose no risk of bowel incarceration (getting stuck in the hernia), but it could cause pain. No, it would not be routine to take down the peritoneum as this is a big undertaking and would only be done if one was anticipating placing a preperitoneal mesh.

    For a surgeon, a sliding inguinal hernia specifically refers to part of the hernia sac being the bowel, usually the colon. Sliding hernias are generally fairly large and easy to see on a CT scan or any other study. It is very difficult to differentiate small inguinal hernias from femoral hernias on physical exam and it is possible to confuse them on imaging. It really shouldn’t matter for a laparoscopic repair as it is quite easy to see the entire area at the time of surgery and most repair techniques cover both the inguinal and femoral spaces. All hernias, including spigelian hernias may contain only fat. Smaller hernias will contain preperitoneal fat, which is a layer of fat between the deep fascia (connective tissue) and the peritoneum (the membrane that lines the abdominal cavity). Hernias may also contain omentum, which is a curtain of fat that hangs over the bowel.

    A flank bulge can be caused by numerous things including a hernia. A spigelian hernia will be a bulge on the edge of the abdominal muscle (rectus abdominus), usually below the level of the belly button.

    A true flank hernia is quite rare unless you have had surgery through the flank, usually to remove a kidney or for vascular surgery. I would not expect a flank hernia to affect the thigh.

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