Peritoneography (Herniography) for Detecting Occult Inguinal Hernia in Patients with Inguinodynia

Abstract

ObjectiveTo evaluate the usefulness of peritoneography in patients referred with inguinal pain (inguinodynia) and clinically absent inguinal hernia on physical examination. Summary Background DataIn patients with chronic groin pain, peritoneography is a seldom-used yet available technique that can detect an occult inguinal hernia. The value of peritoneography in the diagnosis of occult inguinal hernia has been previously shown. MethodsDuring a 60-month period, 80 consecutive patients with complaints of persistent inguinal pain (inguinodynia) without evidence of hernia on clinical examination were referred for outpatient evaluation by peritoneography. Twenty-nine patients had prior inguinal surgery in the region of their current pain. Peritoneography was performed using a midline or paraumbilical approach. Radiographs were obtained with patients in prone and prone oblique positions with the head elevated 20°t o 25°, both with and without provocative maneuvers. All available records were retrospectively reviewed for radiographic findings and outcome. ResultsOf the 80 patients undergoing peritoneography, 36 (45%) were diagnosed radiographically to have inguinal hernias that were not detectable clinically. Twenty-seven of these patients subsequently underwent inguinal exploration, and a hernia was confirmed in 24 (89%). Of the patients having prior inguinal surgery in the region of their pain, 12/29 (41%) were diagnosed by peritoneography with a hernia. Two complications (2.5%), both colon perforations that did not require significant intervention, occurred as a result of peritoneography. ConclusionsPeritoneography is highly reliable for detecting clinically occult inguinal hernia and has a low complication rate. Its usefulness is shown in a prospective consecutive series for detection of occult hernias in patients with chronic inguinal pain. The authors conclude that peritoneography is a safe and useful diagnostic test in the setting of persistent inguinal pain and a negative clinical examination.

Pubic inguinal pain syndrome: the so-called sports hernia

“…The injury results from repetitive avulsive trauma near the pubic symphysis, usually involving the adductor muscles or gracilis. The history may include a direct blow to the symphysis or pelvic instability from a sacroiliac joint injury [1,3,5,8,[21][22][23][24].…”

“…The majority of patients complain of unilateral inguinal pain, often radiating to the pubic tubercle and inner thigh or across the midline, and may recall the speciWc event that initiated the pain, but, more often, the onset is insidious, and the patients associate activities such as kicking, sprinting or cutting with the elective pain. The symptoms are exacerbated by activity and temporarily relieved with rest [1,2,11,15,22]. The pain often manifests as a point tenderness over the pubis at the rectus abdominis muscle origin.…”

“…The history must include questions directed at referred lumbar abnormalities, including back pain, radiculopathy and sensory disturbances [1,2,6,16,[22][23][24]27]. Night pain and persistence of pain at the rest may indicate the presence of a neoplasm.…”

“…Night pain and persistence of pain at the rest may indicate the presence of a neoplasm. Urologic information must be gathered, including urinary symptoms and any testicular lumps or masses [3,[22][23][24]28].…”

“…• Malycha repairs the posterior inguinal wall in two layers: a continuous suture is inserted from the pubic tubercle to the internal ring, followed by a second layer [1,7,22].…”