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Occult Hidden Inguinal Hernia in male? Any experiences?

February 23 2015 at 2:31 PM
DislikeOfHernias 
from IP address 72.35.142.163

Are there any males that have had an experience with a hidden or occult non-palpable inguinal hernia? Are there any doctors who have seen and dealt with a non-palpable inguinal hernia that has no display but is symptomatic (inguinal pain and scrotal contents pain)? If so, what was the experience and what was the resolution?


 
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Jerry

24.0.45.246

Occult hidden inguinal hernia in male? Any experiences?

February 23 2015, 9:35 PM 

I had the same experience with no hernia specialists or urologists being able to detect an inguinal hernia that I knew I had and felt.

I found out about a “Musculo-skeletal ultrasound” which is used for imaging joints, tendons, muscles, soft tissue, ligaments, etc. The testicles do not get imaged because the focus is on the landmark anatomy of the inguinal ligament, femoral canal, inguinal canal with content of spermatic cord or round ligament, inferior epigastric vessels, conjoint tendon, deep and superficial inguinal rings. I was lying down and had some concerns about retraction if there was indeed a hernia but the tech kept asking me to hold my breath and strain. Finally someone got it! I was to be imaged with the Valsalva maneuver! When the test was over the radiologist came in and proceeded to show me a video of my imaging test. Everything looked normal except when I started to hold my breath and strain you could see actually and easily the hernia sac poking through the internal ring! It found my inguinal hernia! Granted it was only a centimeter but this test was awesome at finding it. And guess what? A recent journal article shows that this test is 100% accurate for showing occult hernias and ones that could not be detected through physical examination.
So please, get your doctor to send you for the right tests with the right protocols, tell them that this should be the gold standard test for inguinal hernias and that they should not always assume that the more sophisticated and expensive tests are the way to go – and tell them not to expose you to any unnecessary radiation. Under billing, it shows as Code # 76705 and is called “Ultrasound of Abdomen” for some reason. However, I would make sure that your physician uses the terminology “Musculo-sleketal ultrasound of the inguinal area with Valsalva.” This will ensure that even a retracted hernia will be discovered due to the straining and the way that makes a hernia “pop out.”

Oh and It costs a fraction of other diagnostic tests such as MRI and CT and Medicare paid the facility a mere $99.57 for my study.


References:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964363/
Ann R Coll Surg Engl. May 2003; 85(3): 178–180.
doi: 10.1308/003588403321661334
PMCID: PMC1964363
The groin hernia - an ultrasound diagnosis?
Mike Bradley, D. Morgan, B. Pentlow, and A. Roe
Full article can be found on
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964363/pdf/12831490.pdf


 
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DislikeOfHernias

72.35.142.163

Hidden inguinal hernia

February 24 2015, 12:29 PM 

Hey Jerry, thanks for the response and added details. I had that exact study done (US with Valsava) and it showed a suggestion of a small hernia and some swelling of the cord structures, but doctor is not convinced a hernia is the cause of the regional pain.

Do you mind sharing what your personal experience with symptoms, pain and discomfort was like, and where it was located with your non-palpable inguinal hernia? Did the pain resolve with surgery? What surgery type did you go for? Would you do it again?

The idea of having surgery on the groin freaks me out, I am sure many guys can relate!

 
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Jerry

24.0.45.246

Occult hidden inguinal hernia in male? Any experiences?

February 24 2015, 5:02 PM 

You are very welcome. I'm always glad to help out a fellow hernias sufferer.
My initial symptoms were rather baffling to the surgeon's who examined me and I never really got an explanation for them which kind of makes me wonder if I don't have a very unique situation. I do know that I have both a direct hernia and an indirect hernia on that same side - possibly what is called a pantaloon hernia. For me, the most notable symptom is what is called a retractile (or high riding testicle) and with that came a lot of achiness and some pain. And now that the hernia has gotten bigger the pain in the inguinal canal and in the testicle have gotten a bit worse.

I held off on surgery and thought I could get away with watchful waiting but I really don't want to live the rest of my life having to contend with this. So I actually made an appointment with Dr. Goodyear on March 4th to discuss my surgical options and get his recommendations. I'll keep you posted if you're interested. By the way, your swelling of the cord structures could be due to a number of things but one of the more common things would be a lipoma of the spermatic cord. That sort of finding would be evident at the time of your hernia surgery and would be addressed.

 
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Darius

50.253.179.189

Hidden inguinal hernia

March 2 2015, 2:47 PM 

Jerry -

I may be in the same boat. Thank you SO much for your ultrasound reference. Please provide an update on this thread following your appointment with Dr. Goodyear. Hopefully, they are closer for you than I am in South Florida.

I will contact the surgeon who was highly recommended but could not get a hernia to 'present' and dismissed my discomfort last April (at least he didn't rush to cut me open like some other physician may have) and see if he can schedule such an ultrasound for me.

I am 38 years old and don't want to live the rest of my life with this discomfort.

Thanks,
Darius

 
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Jerry

24.0.45.246

Hidden Inguinal Hernia

March 8 2015, 2:45 PM 

Hi Darius,
Well, since you asked for an update following my appointment with Dr. Goodyear I am happy to oblige.
As I mentioned, the appointment was on March 4 and I had a great visit with Dr. Goodyear and found him friendly, accommodating, and very confidence inspiring. He confirmed that I was right about having a pantaloon hernia and despite the added complexity of dealing with that type of hernia and its reported higher rate of recurrence, Dr.Goodyear did not find it to be a challenge in the least. He was also willing to accommodate my request to have another hernia repaired at the same time. This one is above the belly button and is alternatively called a trochar, incisional, or epigastric hernia. I am thrilled to be able to have the two hernias addressed during the same surgery even though the recovery will undoubtedly be a little bit more difficult.
I am also very happy with the prospect of not being put under general sedation since I have severe sleep apnea and bradycardia (slow heart rate) which makes general anesthesia more risky for me. I must admit however, that the prospect of being even semi-awake while being cut down there does not thrill me but it is what I need. Plus, G. stated that he likes to have his patients cough to determine the effect on the hernia repair and he even said that he could take steps to ensure that my testicle descends into the scrotal sac by tweaking the cremaster muscle.
The only thing that I'm not thrilled about is mesh but at the same time I have to recognize that I'm a very hernia prone person and that I need some sort of "scaffolding" to reinforce the defect and protect areas around it from becoming herniated.
I seriously think it would be well worth your trip to travel up to Lansdale Pennsylvania to see Dr. Goodyear. Believe me, I have studied hernias for years now and have compiled a whole resource directory and I'd be hard-pressed to find anyone, at least in my situation, that I would trust more than Dr. Goodyear.
Best of luck to you,
Jerry

 
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Darius

50.253.179.189

Hidden Inguinal Hernia

March 14 2015, 11:20 AM 

Jerry,

Thank you for taking your time to respond and so comprehensively. I truly appreciate it. I am going this Wednesday for the same ultrasound you had performed to confirm what I am dealing with here.

I will give Dr. Goodyear and North Penn serious consideration, but I live in South Florida and the prospect of traveling for surgery and having to recover in a hotel thereafter is not ideal, but may be the best course of action.

Are you near their facility or would you be traveling some distance?

-Darius

 
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