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  • No hernia on MRI or CT scans

    I was training for a marathon recently. After a long run, I got ill. I now have a bulge in my lower right abdomen. I feel a constant dull ache in the bulge, pain when I bend and can no longer run. My stomach gets extremely distended and I get nauseous when sitting for long periods. I have had CT scans and an MRI- no signs of a hernia. I saw a surgeon and he feels the bulge is not a hernia. He has no explanation for the bulge. My bowel movements have changed since this. He is sending me to GI for further testing and is concerned about the distention. Could this be a hernia? Is there any way to find a hidden hernia without exploratory surgery?? Thanks!

  • #2
    You could try having a dynamic ultrasound with valsava directly on the spot of the bulge / discomfort. Often that ultrasound is done both laying with valsava and standing with valsava. It may see something that wasn't found on the MRI / CT since you are usually laying down for those procedures.

    It seems reasonable to investigate GI causes as well.

    Keep us updated on your case and decision making, good luck.

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    • #3
      Thanks for the suggestion on the dynamic ultrasound. I did have one done recently and the ultrasound dr. and tech were unable to find anything. The dr. said he was “baffled” as there is clearly a bulge that is causing discomfort. He did not see any hernia or muscle tear. He did think the muscle did not look as smooth/thick as the muscle on my other side. I’m at a loss as to what to do next. I have a follow up with my GP and scheduled a consult with a sports PT. All the symptoms fit the description of a hernia... any other ideas what this could be if not a hernia? Thanks!!!

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      • #4
        It seems like the issue might be more about when the "thinning" actually starts causing pain. How much bulge? Does there need to be a "breakthrough" in order to have something to fix? And, of course, how to fix it otherwise. You said that the ultrasound did not show anything. Do you mean that you could see an external bulge but no bulge via ultrasound? That kind of doesn't make sense.

        This seems like another situation where you need to find somebody very experienced. I just mentioned this in another post - don't be the patient that your doctors are learning from. Since you got the injury from training for an athletic event, seeking help from a surgeon who works on athletes makes sense. Don't get locked in to what your insurance system allows. You can waste a lot of time trying to work with the typically limited selection of experts available in most insurance plans.

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        • #5
          Thank you! The bulge is visible when standing, however, the US dr said he did not see anything abnormal- no tears, holes, blockage, etc. Every dr/specialist I’ve seen has been able to to see the bulge along my muscle, but when felt or imaged, say they do not find anything consistent with an actual hernia.

          I am in Denver and am trying to find the right specialist, but am struggling to know who that is at this point...

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          • #6
            I recall reading that "inguinal disruption" can sometimes be described as a 'thinning' that is observable in the groin on ultrasound, you may want to read a bit about Dr Ulrike Muschaweck (leading German hernia surgeon) or perhaps even inquire directly with their clinic.

            Where exactly is the bulge? Is it in the region that a standard groin hernia would appear?

            You might also try sending any CT/MRI images to a hernia specialist to review them directly, as many doctors just look at a radiologist report and do not look at the images themselves. Furthermore, many radiologists reviewing a CT/MRI may not note a hernia or even see one. Dr Shirin Towfigh is well known for reviewing images herself, for example.

            For finding a true hernia specialist you may need to travel out of state. I know it sounds bizarre that even in major cities many do not have a true hernia specialist, but our medical system has determined that hernias are part of the "general" surgery category and so there is very little specialization if a doctor does not directly seek out that specialization themselves out of a direct interest in hernias. Personally I think that is an industry reform that should happen sooner than later, every hospital/facility should have designated hernia surgeons to master the craft through repetition and thousands of procedures, rather than assign them randomly across hundreds of surgeons who may only do a few repairs a year... but now this is getting off topic

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