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

5. Groin Pain: An Overview of the Broad Differential Diagnosis
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test and beta hCG can help quickly diagnose an ectopic pregnancy [ 20 ].
The spectrum of conditions causing ovarian cyst formation and subsequent
rupture can range from benign physiologic conditions, such as
ovulation in the case of corpus hemorrhagicum, to malignant processes.
Large cystic lesions such as benign mature cystic teratomas, hemorrhagic
cysts, and cystadenomas increase the risk for ovarian torsion by
predisposing the ovary to swing around its vascular pedicle [ 21 ].
Ultrasound imaging is commonly used to elucidate the diagnosis.
Hemodynamic instability can occur in all settings, and surgical options
include cyst excision and oophorectomy [ 22 ].
Secondary Inguinodynia
Ironically, chronic postoperative groin pain is one of the major complications
of inguinal hernia repairs with significant long-term pain seen
in a small proportion of patients after surgery. Stimulation, entrapment,
or injury to the nerves during hernia dissection can produce long-term
sequelae of neuralgia, paresthesia, hypoesthesia, or hyperesthesia. The
genital branch of the genitofemoral nerve, ilioinguinal nerve, and iliohypogastric
nerve are at risk with an open approach, while the lateral femoral
cutaneous nerve, anterior femoral cutaneous nerve, and genital or
femoral branch of the genitofemoral nerve are at risk with a laparoscopic
approach. Chronic groin pain can be potentially disabling, with significant
impact on quality of life.
The true incidence of chronic groin pain after inguinal hernia repair
is hard to determine, with varied incidence reported in the current literature.
A prospective series of 419 subjects after open hernia repair found
19 % had reported residual pain at 1-year follow-up, with 6 % reporting
moderate to severe pain. Recurrent hernia and high pain score at 1- and
4-week post-op were identified as predictors of developing moderate to
severe pain [ 23 ]. Mesh use, nerve division, use of lightweight meshes,
and laparoscopic repair have all been studied for potentially reducing
post-herniorrhaphy pain, with only the latter two having shown potential
benefit [ 24 ].
A recurrence must be ruled out when confronted with this complication.
Remnant cord lipomas from original surgery must also be distinguished
from a recurrence. Neuropathic pain can be managed like other
chronic pain conditions. Anti- inflammatory medications, tricyclic antidepressants,
nerve blocks, and acupuncture are all viable modalities,