Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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S. Towfigh
Physical Exam
The patient was in discomfort while sitting at the edge of the chair.
He had a healed groin scar and no visible bulge. Palpation elicited 3+
tenderness at the internal ring and along the spermatic cord. A mass of
mesh was palpable laterally. He had 3+ hypesthesia and allodynia at the
right groin scar and scrotal skin. The testis was descended and without
associated tenderness or mass.
Imaging
Magnetic resonance imaging of the anterior pelvis, non- contrast, with
Valsalva and dynamic views demonstrated intact flat onlay mesh with no
hernia recurrence (Fig. 39.1 ). He has a significant varicocele on the
right. There is no inflammatory reaction noted around the mesh.
Diagnosis
The patient was diagnosed with ilioinguinal neuralgia . This was due
to direct injury at the time of his operation versus entrapment due to scar
or mesh. He had no other obvious causes for his postoperative pain,
including no evidence of hernia recurrence, infection, inflammation, or
meshoma. He was offered nonsurgical treatment as the initial modality
Fig. 39.1. MRI anterior pelvis, non-contrast, with Valsalva and dynamic views
demonstrated intact right inguinal hernia repair with no hernia recurrence. T2
axial view here shows intact flat onlay mesh ( yellow arrow ).