Can Medical Imaging Accurately Diagnose Hernia Symptoms?

Hernia - Is there an instrument that can confirm the diagnosis?

Hello Dr.
Hsu,
In late July, I experienced discomfort at a point 8 cm to the right of my navel.
Throughout the day, I would feel sharp pain about three times, lasting around five seconds each time.
Pressing on the area and releasing did not cause pain, and there were no visible bulges in my abdomen.
Earlier this year, I underwent a colonoscopy, which showed no abnormalities.

In early October, I visited a hospital for an examination, where the doctor performed a digital examination from above the base of my genitalia and suggested that I have a hernia, recommending surgery and advising that a mesh should be placed on both sides to prevent pressure differences, as a hernia could develop on the left side in the future.
However, after returning home, I found it strange that the sharp pain in my lower right abdomen did not occur again.
A little over a week later, I consulted a clinic specializing in hernias.
The doctor stated that I did not appear to have a hernia, as hernias typically do not cause pain, and the point of sharp pain I described was not consistent with a hernia.
He also mentioned that the digital examination from the base upwards is not very accurate (he demonstrated this, and it was somewhat painful).
He advised me to avoid surgery for now and to monitor the situation.
After returning home, I noticed that both doctors' examinations caused a slight sensation of heat and discomfort in the area, particularly at the starting point above the base of my genitalia.
Since my wife is a nurse, she provided me with anti-inflammatory medication for four days.
Currently, the starting point feels warm but no longer painful, although I still experience slight discomfort in the area above.
Recently, I have also noticed some swelling in the scrotum, and sitting has become uncomfortable.
Additionally, I have switched from wearing a belt to suspenders, as the previous sharp pain point coincided with where the belt would sit.
Although I am slim, I have a slight belly above the belt line, while below the belt line, I am completely slim.
I would like to ask Dr.
Hsu what I should do, given that my abdomen does not show any obvious bulging and the two doctors have differing opinions.
Are there any diagnostic tools that can definitively determine whether I have a hernia? Can ultrasound or MRI detect it? Or could it be that the initial sharp pain was simply caused by long-term pressure from the belt?

Ching, 40~49 year old female. Ask Date: 2017/10/31

Dr. Xu Kaixi reply Surgery

Based on your description, the likelihood of a hernia is low.
For a more accurate diagnosis, a computed tomography (CT) scan may be considered.

Reply Date: 2017/10/31

More Info

When it comes to diagnosing hernia symptoms, medical imaging can play a crucial role, but it is not always definitive. Hernias occur when an organ or tissue protrudes through a weak spot in the abdominal muscles, and they can present with various symptoms, including pain or discomfort in the affected area. In your case, the discomfort you experienced near the umbilical region and the subsequent evaluations by different physicians highlight the complexity of diagnosing hernias.

Firstly, it's important to understand that hernias can sometimes be asymptomatic or present with vague symptoms, making them challenging to diagnose. The absence of a visible bulge or protrusion does not rule out the possibility of a hernia. In fact, some hernias, such as inguinal hernias, may not always present with a noticeable lump, especially in the early stages.

In terms of imaging, ultrasound is often the first-line investigation for suspected hernias. It is non-invasive and can effectively visualize soft tissue structures, making it useful for detecting the presence of a hernia and assessing its size and contents. However, the sensitivity of ultrasound can vary depending on the operator's experience and the patient's body habitus.
Magnetic Resonance Imaging (MRI) is another option that can provide detailed images of soft tissues and may be particularly useful in complex cases or when other conditions are suspected. MRI is highly sensitive and can help differentiate between a hernia and other potential causes of abdominal pain, such as muscle strains or nerve entrapments. However, MRI is generally more expensive and less accessible than ultrasound.

In your situation, given the conflicting opinions from different physicians, it may be beneficial to pursue an ultrasound examination if you haven't already. If the ultrasound results are inconclusive, an MRI could be considered for further evaluation. Additionally, if the pain persists or worsens, or if you develop new symptoms, it would be prudent to follow up with a healthcare provider.

It's also worth considering that your symptoms could be related to other factors, such as pressure from your belt or changes in your posture. The discomfort you described in the groin area could be due to muscle strain or irritation rather than a hernia. The fact that your symptoms improved after changing your clothing habits (switching from a belt to suspenders) suggests that external pressure may have contributed to your discomfort.

In conclusion, while medical imaging can aid in diagnosing hernias, it is not infallible. A thorough clinical evaluation, including a detailed history and physical examination, is essential. If imaging studies are inconclusive, and if your symptoms persist, seeking a second opinion or consulting a specialist in hernia repair may provide further clarity. Remember to communicate openly with your healthcare providers about your symptoms and concerns, as this will help guide appropriate diagnostic and treatment strategies.

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