Abdominal Lumps: Lipoma, Hernia, or Fibroid?

I have a hard lump in my abdomen... Is it a lipoma, a hernia, or a fibroid?

Hello Doctor: About six years ago, I underwent laparoscopic surgery for uterine fibroids.
There is a 3 cm surgical scar located to the left of my abdomen, about three fingerbreadths below the navel.
Approximately two years after the surgery, I started to feel something hard underneath the scar.
I thought it might be due to adhesions or other reasons related to my body type, and since it was small, I didn't pay much attention to it.
The hard lump gradually grew larger, and occasionally I would feel a dull aching sensation when it was pulled.
This year, it has grown even larger, about 5-6 cm, and is quite prominent and hard to the touch.
I instinctively felt it was related to the surgical site, so I consulted with an obstetrician-gynecologist.
Doctor A said it was a hernia.
I then saw General Surgeon B, who said it didn't look much like a hernia because of its higher position and that it wasn't very mobile, and advised me to undergo further examination.
Later, due to menstrual issues, I visited a nearby gynecologist, Doctor C, who performed an ultrasound on the protrusion and said it was not a hernia but a fibroid, possibly remnants from the original uterine fibroid removal that later developed independently.
I was confused, so I went back to Doctor A for clarification, who insisted it was a hernia, formed by fat accumulation, and different from typical male hernias.
The cause might be related to obesity and increased abdominal pressure, and if it causes discomfort, he suggested laparoscopic surgery to address it.
So, what exactly is this hard lump? If Doctor A is correct and it is fat accumulation, could it also possibly be a lipoma? Doctor, please advise me on what I should do, which specialty I should consult, and what examinations can determine what this is.
I am not keen on undergoing general anesthesia for surgery again; are there other ways to manage it? I would greatly appreciate your guidance.
Thank you!

kawa, 30~39 year old female. Ask Date: 2016/07/14

Dr. Chen Jiaming reply Surgery

Most abdominal wall hernias that occur after traditional surgery with large incisions are caused by weakness or poor healing of the muscle and fascia layers, allowing contents from the abdominal cavity (which can include intestines or the greater omentum, a fatty tissue) to protrude.
Generally, when lying flat with the legs bent and the abdominal wall relaxed, the hernia can often be pushed back into the abdomen, as acute incarceration typically induces significant pain.
However, since you underwent laparoscopic myomectomy, the likelihood of developing a hernia is lower due to the smaller incision; nonetheless, it can still happen.

Given that different physicians may have varying opinions and your concern about unnecessary surgical intervention, I recommend consulting with Dr.
A to see if an abdominal CT scan can be arranged for further confirmation.
If it is determined that the scan does not meet the criteria for coverage under health insurance, you might consider paying out-of-pocket for the examination (approximately 4,000 to 5,000 NTD if no contrast agent is used).
Generally, if you have a larger body type with a thicker layer of internal fat, the CT scan may provide better contrast.

If the scan reveals that discomfort is due to protruding fat or a hernia from the abdominal cavity, laparoscopic surgery would be a good option.
If it is merely an enlarging subcutaneous lipoma, it can be excised directly or monitored.
As for any residual fibroid tissue that may have grown, it would be best to let a gynecologist explain and make decisions regarding that.
I hope this information is helpful to you.

Reply Date: 2016/07/14

More Info

Understanding the nature of abdominal lumps can be quite complex, especially when there are multiple opinions from different specialists. Based on your description, it seems you have a lump in your left abdomen that has grown over time and is associated with a history of laparoscopic surgery for uterine fibroids. The differential diagnosis for such a lump includes hernias, lipomas (fatty tumors), and possibly residual fibroid tissue or scar tissue from your previous surgery.

Hernia vs. Lipoma vs. Fibroid
1. Hernia: A hernia occurs when an organ or tissue pushes through a weak spot in the surrounding muscle or connective tissue. In your case, if the lump is indeed a hernia, it would typically be reducible (able to be pushed back into the abdomen) and might be associated with discomfort, especially when straining or lifting. However, the fact that your lump is not easily movable and has a firm consistency may suggest it is not a typical hernia.

2. Lipoma: A lipoma is a benign tumor made of fat tissue. They are usually soft, movable, and painless. If the lump feels hard and is not easily movable, it may not be a lipoma, but it is still a possibility, especially if it is a deeper-seated lipoma.

3. Fibroid or Residual Tissue: Given your history of fibroid surgery, it is plausible that the lump could be residual fibroid tissue or a new fibroid that developed post-surgery. Fibroids can sometimes grow in unusual locations, and if they were not completely removed during the initial surgery, they could potentially reappear.

Diagnostic Approach
To clarify the nature of the lump, the following steps are recommended:
1. Ultrasound: Since you have already had an ultrasound, it would be beneficial to review the findings with a radiologist who specializes in abdominal imaging. They can provide insights into the characteristics of the lump, such as its composition (solid vs. cystic) and vascularity.

2. MRI or CT Scan: If the ultrasound results are inconclusive, a more detailed imaging study like an MRI or CT scan can help differentiate between the types of tissues involved and provide a clearer picture of the lump's relationship to surrounding structures.

3. Consultation with a Specialist: Given the conflicting opinions from different doctors, it may be wise to consult a general surgeon who has experience with abdominal wall issues. They can perform a physical examination and may recommend further imaging or even a biopsy if necessary.

Treatment Options
If the lump is confirmed to be a hernia, surgical intervention is often recommended, especially if it is causing discomfort or has the potential for complications. If it is a lipoma or residual fibroid tissue, treatment may vary. Lipomas can often be left alone if they are not causing symptoms, but if they grow or become bothersome, surgical removal is an option.

Recovery Considerations
If surgery is required, recovery time can vary based on the type of procedure performed (laparoscopic vs. open surgery). Generally, laparoscopic procedures have a quicker recovery time, often allowing patients to return to normal activities within a week or two, while open surgery may require a longer recovery period.

Conclusion
In summary, the lump you are experiencing could be a hernia, lipoma, or residual fibroid tissue. The best course of action is to pursue further imaging studies and consult with a general surgeon for a thorough evaluation. It is understandable to be apprehensive about surgery, but obtaining a clear diagnosis is crucial for determining the appropriate management plan. Always feel free to seek a second opinion if you feel uncertain about the recommendations provided.

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