[jeanvic]

Hello Dr Towfigh,

from the journal Hernia a review of the accuracy of CT to diagnose groin hernias (inguinal and femoral). The very last paragraph is from my doctor to me.

Best, Jeanie

JOURNAL ARTICLE
Computed tomography scan diagnosis of occult groin hernia
J F W Garvey
Hernia: the Journal of Hernias and Abdominal Wall Surgery 2012, 16 (3): 307-14
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BACKGROUND: The value of computed tomography (CT) for the diagnosis of clinically occult (hidden) groin hernia was assessed in a series of patients presenting with undiagnosed groin pain.
METHODS: A total of 158 consecutive patients presenting over a period of 5 years with undiagnosed groin pain or lower abdominal pain and negative or equivocal clinical findings were radiologically assessed with non-contrast CT. The decision to manage operatively or conservatively was then based on a combination of the clinical and CT findings. Outcomes were assessed at 10 years follow-up.
RESULTS: The study cohort comprised 158 patients presenting with groin or lower abdominal pain and/or swelling, and was studied prospectively. Seven of these patients were re-investigated at a later date after developing new pain on either the ipsilateral or contralateral side, giving a total of 165 CT examinations. One-third of cases (54) had clinically occult groin hernias and most of the remaining cases had diagnoses that could be managed non-operatively. Of those who came to surgery, the pre-operative CT diagnosis of hernia had a positive predictive value (PPV) of 92% and a negative predictive value (NPV) of 96% (overall accuracy 94%). Lipoma of the spermatic cord was responsible for three of five false-positive CT results. The concept of sports hernia/groin disruption injury (GDI) was encountered, and this entity is discussed in this paper. In the group of patients without hernia findings on CT, the most common diagnoses were rectus abdominis and/or pyramidalis muscle injury which could be treated by physiotherapy (22%), GDI (16%), post-surgical problems (14%), miscellaneous (20%) and ‘no abnormality’ was identified in 15%. Overall, there were 111 patients with a ‘non-hernia’ CT diagnosis, of which urological, gynaecological, gastrointestinal and neuralgia contributed to the non-musculoskeletal diagnosis.
CONCLUSION: This prospective non-contrast CT study of patients with undiagnosed chronic groin pain detected the majority of occult hernias requiring surgical intervention. These results suggest that CT can be a useful adjunct to the evaluation of patients presenting with chronic undiagnosed groin pain, but that experienced clinical judgment remains a critical element in the diagnostic pathway.
Based on this large series— CT scan had a negative predictive value of 96%– meaning if the CT is negative there is a 96% that you truly do not have a hernia- which does leave a 4% or 1 in 25 chance there is a hernia.

So I would say complete the other evaluations and then we can talk. I could perform a diagnostic laparoscopy but as I said I think the chance of finding something in < 10% while this article with a large number of patients would say in the face of a negative CT for a hernia the chance of me finding a hernia as a cause of your pain is 4% (meaning the CT would be wrong). Now a 1 in 25 chance is not good but again even a negative laparoscopy may be helpful going forward as at least you would know that there is no intra-abdominal pathology to explain your pain.

[jeanvic]

I have also described the burning pain as a very bad sunburn but sometimes it feels like my legs are on fire. Pretty unbearable pain. I will look up Dr Belyanski, thank you. Yesterday’s hernia surgeon emailed me an article from a hernia medical journal that did a study on CT scans predictability accuracy and it was around 95%. Thanks again.

[jeanvic]

One more question, Jnomesh, are you female or male? And thank you for saying pain can be below knee. That is most encouraging and I really appreciate you sharing your experience.

[jeanvic]

Thank you Jnomesh. You give me encouragement. I was feeling discouraged yesterday when the surgeon told me I had a less than 10% chance of having a hernia because my CT scan was normal. After the doctor pressed my abdomen and I felt pain but he couldn’t find a bulge, the top of my left pinky toe started to hurt after I went home. I assumed it was a seam in my sock that was scratching me but the pain is still there this morning, no sock and hurts just from walking barefoot. It feels like I have a series of scratches on the top of the toe but nothing visibly scratched. I thought ‘can the pressing of the abdomen cause this new pain’ or is it just a coincidence? There is some crazy connection! I will look for another doctor. Are surgeons the best doctors to call?

[jeanvic]

The abdominal pain is mostly on the left side, below belly button, groin region. When I’m sitting, it is right around the crease where my abdomen meets my left leg. The majority of my distress comes from burning sensations – it feels like I’m sitting on a bad sunburn, going down my legs to my knees. I sit with a bottle of ice water between my legs to relieve the pain. I just came back from a hernia surgeon who doesn’t think I have a hernia because my CT scan didn’t show anything. He said CT scan would be better than MRI for detecting hernias. He said he could try a diagnostic laparoscopy to rule out hernia. Thank you for your reply. I forgot to check this board before my doctor’s appointment and wish I knew to ask about the ultrasound with valsalva.

[jeanvic]

What kind of tests did the ER do to find your hernia? I am in severe abdominal pain. CT showed small cyst on my kidney but doesn’t explain all the pain. Primary care doc is sending me to a urologist. I still suspect hernia, just because so much pain in abdomen and burning down legs. Maybe something pinched. Appreciate any help or advice you can give, thanks.

[jeanvic]

I have both groin pain (left lower abdomen) and left foot pain! Pain started in my foot and spread to my abdomen. My abdominal pain is getting worse while the foot pain has stabilized. I have strong burning pain from groin to knees. Relieved by lying down or ice. I sit with an ice pack to relieve the pain. I am wondering if I have a hidden hernia. What kind of doctor do I need to see? I’ve seen podiatrists (foot MRI negative), neurologists (EMG negative), pain specialists, GI (pressed on my abdomen and felt pain – left to center, below belly button). Looking for a hernia specialist or urogynecologist near 11358. Any insights or input very much appreciated. Abdomen pain started in Sept and getting worse.

[jeanvic]

Thank you for your reply Jnomesh. I had a CT scan of my abdomen yesterday. I had a lower back MRI that was done before the pain in my abdomen got worse and it was negative. I do have small twinges in my back but the pain is mostly in the front left and center of my abdomen, below the belly button. The burning pain in my abdomen and legs gets worse when I sit and gets better when I lie down. I am having trouble finding a urogynecologist in NYC. I will look up Brian Jacobs, thank you so much!!