drtowfigh
Forum Replies Created
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Are these symptoms of an “occult female hernia?
Sounds very likely to be a hernia. Other options may be hip-related issues, but your symptoms certainly are more consistent with an inguinal hernia.
I am happy to see you in consultation. Your MRI needs to be Re-read to make it is correctly interpreted. -
Hernia Surgery Risks in an 88yr old Woman
It’s too early to say. If it’s better with walking then that’s a good sign. The area is tighter than she was so it’s normal to feel pain when engaging the muscles such as to get up from a chair or out of bed.
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Are these symptoms of an “occult female hernia?
Absolutely can be signs for an occult hernia.
Do you have pain with coughing, laughing, getting out of bed or car, prolonged sitting, prolonged standing? Is it worse at the end of the day, better when lying flat? Worse with your period? Painful with sexual intercourse? Do you feel a lump or swelling at the groin area or above the crease? Does the pain radiate down the top of your thigh, around to your hip, to your back, up to your belly, or into your vagina?
Ice helps.
What did your hernia surgeon say? Did the ultrasound or MRI pelvis remark about the hernia area at all?
Go to the American Hernia Society web page or let me know which part of town you live so we can help you find a specialist who can evaluate you. -
Pre-Surgery Diagnosis Needed?
The area and symptoms may be due to a Spigelian or interstitial inguinal hernia. Hard to believe it was missed on CT but it’s been known to happen. A Valsalva image (CT or MRI) helps view small hernias best.
You can have your images re-read by a local radiologist as a consult or I am happy to review them. Ileostomy seems extreme for your problem and based on your GI workup is low likely to resolve your symptoms. Upon laparoscopy, the peritoneum needs to be taken down to be completely sure there is no hernia. I assume that was not done with your last laparoscopy. And during loop ileostomy depending on the technique they may not do anything more than a right lower quadrant incision.
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Hernia Surgery Risks in an 88yr old Woman
Surgical site infection is always a concern. I recommend showering with soap or antibacterial agent (Hibiclens) the night before and the day of surgery.
Make sure she does not have a uronary infection or other infection at the time of surgery.
Blood clots in the legs are dangerous and risky after surgery. Walking a lot before and after surgery will help reduce that.
Do not shave the groin area yourself. Leave it up to the surgeon to do it the same day of surgery.
Eat well. High protein diets tend to offer best healing nutrition. Also, can take extra Vitamin C and Zinc. That also helps with healing.
Take Arnica 12c three times a day starting a few days prior to surgery and continue after surgery. You will notice less bruising, swelling and pain. Let your surgeon know.Good luck!
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What to tell the ultra sound technician
That makes me so happy! 😛 😆
Please promote HerniaTalk to your friends and also your surgeon and their staff.
Great success story. -
Pre-Surgery Diagnosis Needed?
Intestinal problems can be very complicated to diagnose. There are a wide variety of causes of bloating including motility disorders, hypothyroidism, narcotics use, small intestinal bacterial overgrowth, etc. In addition, hernias can cause symptoms of bloating, nausea, abdominal pain.
Typically, the bloating, pain and nausea are due to direct involvement of intestine with the hernia. In my practice, I have also regularly seen patients without intestinal involvement of their hernia (ie, hernia with fat content only) who have bloating, nausea and this resolved after the hernia repair. In analyzing these, it seems that the nausea and bloating are the body’s reaction to the pain from the hernia.
A CT is adequate for evaluation of the abdomen. MRI is more useful for the pelvis. CT with Valsalva (beardown) would be preferable. A careful review of the CT would show the umbilical belly button hernia and any Spigelian hernia. Spigelian hernias typically occur two finger breadths below the level of the belly button and on the edge of the rectus muscle (the abs or six-pack). It sounds like you are describing pain at the same area.
I do not know what studies have been done to evaluate your GI tract. From what you have posted, there is no major motility disorder of the colon, which would be the only reason to perform an ileostomy, and even then that is a drastic procedure and still does not address the colon motility, which remains in situ.
Umbilical hernias may present with pain at their periphery, usually a couple of finger-breadths to the side, but not lower in the abdomen. You may have a simple inguinal hernia. That is much more common than a Soigelian hernia. In such a case, a dynamic MRI pelvis would be helpful. Also, as I explained above, your symptoms may be associated with an inguinal hernia. I have seen it in my practice dozens of times.
Do you notice any bulging or protrusion in the area? Is any of your nausea, bloating, pain associated with activity? Intercourse? Menses? Sitting? Coughing?
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Unusual Abdominal Injury
It’s possible dry needling in the acute stage (6days) may have exacerbated your problem. I am not an expert in this method but typically this method should be reserved until after the acute phase.
Yes, 6 weeks after injury.
6-½ months is a long time, unless you have not allowed it to fully heal, ie no full rest. Typically, for muscle tears, we recommend 3-6 months of complete rest.
Yes, CT or MRI can show this as can ultrasound.
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Post Op Problems From Inguinal Hernia Repair
Yes. It is possible to use only one tack.
Possibly, if you are looking at the instrument log, they logged one tacker (?), which has many tacks in it. The operative report may indicate how many tacks were used. If these are titanium tacks, a simple xray will show the tacks and we can count them. -
Hernia mesh fixation questions
There is no standard. There are randomized controlled trials that have proven that a variety of techniques (tacks or no tacks, glue or no glue) are all adequate. I typically do not tack or glue. For larger hernias or in larger build patients, I tack, because the rate of mesh billowing into the hernia defect is much higher. With the robotic technique, I prefer to sew rather than tack, as it is a more elegant technique to fix the mesh. And I feel that there is less pain than tacking, but that has not been proven. I use titanium permanent tacks and permanent sutures. There is no proof that absorbable tacks are superior or cause less pain. They are just much more expensive. Regardless of the fixation or lack of fixation, mesh can move or fold.
Surgery is as much an art as it is a science. The technique should be tailored to the needs of the patient. A small hernia in a thin patient is treated differently by me than a large hernia in an obese patient. They cannot all be provided the same repair. And still, with the same repair performed on similar patients, two different outcomes may be expected. Each patient reacts to surgery, mesh, etc., differently. We don’t know enough to predict who will do best with which mesh or which technique.
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Does surgery resolve occult hernia pain and symptoms?
Yes absolutely. The main purpose of repairing a hernia is to resolve symptoms.
There is no one repair superior to another. Your surgeon will have that discussion with you and should tailor the repair based on your needs and your surgeon’s practice of preference. The same is true for athletes, male or female.
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Unusual Abdominal Injury
This is clearly an abdominal wall muscle issue and I don’t believe most gastroenterologists will be finding interest in this. I do not feel there is anything intestinal with your story.
The more I think about it, the more I feel you must have had a tear in the rectus muscle. It peaked when it tore off its medial insertion. Then it smoothed out.
Initially, allow your body to heal and follow its natural inflammatory state. Dry needling is good but not in the acute stage. You can dry needle after 6 weeks.
Scar tissue constantly remodels. Do not worry about it. Your body takes care of that. It will not hinder any of your activities.
Minimize rectus muscle engagement exercises. Focus on the transversu abdominis muscles.
Muscles tear when there is an imbalance. For example, it is being tugged more in one direction than another. In your case, either you had not stretched enough, or you made a very rapid movement, or your rectus muscles are too large in comparison with your transversus muscles. There needs to be a balance in order to reduce the amount of strain between muscles. I would focus on that. If you’ve had imaging, you can analyze the girth of each muscle to see which you should focus on more.
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Why is needlescopic hernia repair not performed on adults?
Easy answer: adults are not larger children.
In children: Hernias are anatomical failures to close. The tissue itself is otherwise normal. If you close it surgically, it will heal.
In adults: Hernias are structurally abnormal tissues. They have poor collagen content. The tissue is weak. If you close it like in a child, it will reopen. It needs a mesh to facilitate its closure or strengthen the tissue. Or you need to close it with multiple layers of overlap and accept that a proportion of them may still fail and need mesh. -
Hernia Surgery Risks in an 88yr old Woman
A femoral hernia can be repaired under local anesthesia with some sedation. It is worth repairing especially in a symptomatic patient. The risk of not repairing such a hernia is very high in terms of complications and includes death. â…“ of patients who end up requiring surgery for femoral hernia need it done emergently and among those â…“, 10% do not survive due to complications from bowel strangulation, infection, etc. That is a very very high number. It is best to repair the femoral hernia non-emergently, that is, under controlled elective manner. The assumption is that the patient is healthy enough to undergo repair with less risk for surgery.
I do not recommend laparoscopy for most patients who are 88 years old, even if it is theoretically a superior repair than the open repair especially for femoral hernias. It is not worth the risks of the repair, such as need for general anesthesia.
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Are my symptoms from a hernia?
Some comments:
– hernias definitely have a genetic tendency. In fact in our study, having a female in the family (such as with your mother) has a stronger genetic linkage.
– I agree with Dr Goldstein. Your symptoms do not sound like a hidden hernia or a femoral hernia and let me explain why:– hernias do not cause tailbone pain
– hernias are also usually not crampy. Crampy pain is usually related to obstructions of tubular structures such as the ureter or the intestines.
– lying on the stomach is almost always painful with a hernia
– hernia patients almost never lose weight due to pain or fear of eating due to pain. If anything, they gain weight due to inactivity as most hernias are exacerbated with activities.I would look into internal hernias caused by adhesions or just adhesions alone as the cause of your pain. Though status studies may not show an obvious obstruction, an enterography (either upper GI study or CT/MR enterography) or reevaluation of your prior films may be able to show subtle differences in intestinal caliber or kinking which will lead one to diagnose adhesions as the cause of your pain. If it is so debilitating, and you are not thriving (massive weight loss, for example) and you are otherwise healthy, it may be worth it to perform a laparoscopic exploration, which is an operation.l but it may be worth it’s risks.
You need a general surgeon or a skilled and knowledgeable gastroenterologist who will take his time to look into all of this for you. If Dr Goldstein is offering you his expertise, I would chomp on it! B)
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Trying to Get A Hernia Diagnosis
As we have reported before, a negative ultrasound is not helpful if the clinical suspicion is high for a hernia. That is, there is a high false negative rate with ultrasounds. If there is a clinical suspicion, then further imaging (CT with Valsalva without contrast) may be warranted. That said, for umbilical hernia, a physical exam is all that is usually needed. And if she has discomfort and it affects her daily activities, that warrants intervention.
Before any procedure, I would address the straining with bowel movement. Why is she straining? That is not normal and poses a high risk for hernia development and recurrence after any repair. All straining must be cured prior to any hernia repair. If it is a constipation issue, I recommend to my patients any combination of milk of magnesia, mineral oil, and/or Miralax. -
Post Op Problems From Inguinal Hernia Repair
For some reason, Northern California is completely without any hernia specialists that I am familiar with. Perhaps others can chime in if they know of anyone. Sorry b
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Unusual Abdominal Injury
Thank you for the details as this is certainly a perplexing situation.
I would like to agree with your internist.
I wonder if you developed a tear or the beginning of a diastasis (spreading of the rectus muscles from their insertion in the middle), thus your symptoms. In either situation, there is no active intervention that is taken. Sounds like no hernia. I would not pursue any imaging. I would focus on more transversus abdominis exercises and reduce rectus abdominis and oblique muscle training for a while. That would reduce the strain on the rectus while maintaining your core. There are great forums, videos, and pictures online about transversus abdominis muscle training. Basically it is core muscle training without straining or crunches. These can include planks, squats against the wall, etc.
I would like to hear back from you in a few months after such training. I feel you had a rectus tear or diastasis occur and that is why you had the peak in the muscle and then it settled down with the lingering soreness for a while. Rest it and don’t strain it. No more crunches or engagement of the rectus. Focus on the rest of your core.
I hope this is helpful.
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Post Op Problems From Inguinal Hernia Repair
– pain 2 months after a hernia repair may be due to
A) mesh shrinkage, folding, pulling from the shrinkage
B) indirectly from the tacks (or sutures as the case may be) as the shrinking is pulling on the tacks that are holding it in place)
C) hernia recurrence
D) infection of the mesh (very rare)Tack pain is almost always immediately after the repair and does not present in such a delayed fashion.
You need a thorough evaluation to rule out #C. If there is no hernia recurrence, then dealing with pain from a tightly placed mesh that is now shrinking and pulling on the tacks placed on it is a more difficult problem to deal with. The tacks may have to be removed. Also the number of tacks may play a role in thee extent of pain associated with the shrinkage of the mesh.
I recommend evaluation by a top hernia specialist who has regularly dealt with these situations and is experienced enough to take you through the appropriate workup and treatment plan.
I tend to agree with you that logically speaking you should not all of a sudden have weakening and pooching out of your abdomen from your 4 pregnancies, no so many decades later and despite your athleticism.
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Pain in lower right abdomin
Some facts:
– CT scans are not very sensitive in finding small hernias in the pelvis. If the clinical suspicion for a groin hernia exists, and Cat is normal, a dynamic ultrasound and/or MRI is necessary.
Read this article to help clarify:
http://archsurg.jamanetwork.com/Mobile/article.aspx?articleid=1893806-pain can present with nausea. So perhaps your nausea is due to the hernia pain. I do see this often.
– there are a lot of very good to excellent hernia specialists in Florida, especially South Florida. Please go to the American Hernia Society website and click on Find a Hernia Specialist to find one near you.
– hernia specialists in Florida who are nationally recognized and who I personally know and can vouch for:
Bruce Ramshaw
Eduardo Parra-Davila
Jerrold Young
David EdelmanPlease provide us with a followup. And if it turns out that you had a hysterectomy for naught, please make sure your gynecologist is made aware of your diagnosis.