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

40. Patient with Groin Pain After
Tissue Repair, Anterior Approach
Shirin Towfigh
Chief Complaint
Right groin pain after tissue repair
History
The patient is a 73-year-old male, status post classic Shouldice repair
of his right inguinal hernia 3 months earlier. Preoperatively he had a bulging
hernia with scrotal extension, without significant pain. He now complains
of daily groin pain, 7/10, ranging from 2/10 to 9/10. This began 3
weeks postoperatively after an otherwise uneventful early recovery period
when he was feeling “amazing.” He now reports a feeling of tightness,
like a “rubber band” across his lower abdomen at the level of the repair.
He feels like he wants to “pop out.” The pain is at times burning, sharp,
shooting, or a dull constant pain at baseline. The pain radiates to the upper
inner thigh as a “minor but irritating” burning stinging pain. The pain also
radiates to his flank and he feels pain at his hip bone. He denies testicular
pain. He has swelling of the right groin that comes and goes. He also has
bloating and feels “filled with gas.” He has changed his diet, removed all
dairy, and takes daily probiotics, stool softeners, and anti-gas medication,
with no improvement. He denies constipation or straining.
Physical Exam
The patient gets up from sitting position with mild distress. His
entire lower abdomen seems a bit edematous and bloated. The right
groin has a healed incision and is edematous along the wound and its
© Springer International Publishing Switzerland 2016
B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain,
DOI 10.1007/978-3-319-21587-7_40
479