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Can Hernia Occur Without An Opening In The Abdominal Wall?

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Posted on Thu, 2 Nov 2017
Question: You have answered some of my questions about a suspected hernia in April, 2017. I have recently been checked by a local competent surgeon for a hernia in my lower left groin area after having an ultrasound scan. He has determined that there is no opening in the abdominal wall and therefore no hernia. He stated that areas of swelling & tenderness will heal over time. I have tearing & burning symptoms in a muscle area especially when lifting over 10 lbs., walking too fast, walking up stairs, using a step ladder, or during activity where an impact motion is conducted (using hammer, sledge hammer, axe, etc). QUESTION: can there be a hernia without an opening in the abdominal wall? Can this extreme and debilitating pain be due to a muscle / tendon tear and can this be repaired? If so,h ow would you know where to locate the location of the tear since many of these tissue injuries do not show up in scans?
doctor
Answered by Dr. T Chandrakant (6 hours later)
Brief Answer:
Nerve entrapment or clubbing at cut ends as explained in details.

Detailed Answer:
Hi.
Thanks for your review query.
Noted the previous discussion and the present history in detail.
To answer your questions with explanations and possible remedies:
-Can there be a hernia without an opening in the abdominal wall?
The basic diagnostic feature of hernia is an opening into the abdominal wall that allows the abdominal contents to escape through to form a sac outside of its normal territory is called hernia. Hence is no opening there is no hernia. (although in rare cases like large muscles like that of thigh and calf there can be herniation of muscles though its capsule)

-Can this extreme and debilitating pain be due to a muscle / tendon tear and can this be repaired?
There is a possible remedy for such pain:
Since there is tearing and burning pain the most probable cause is oversensitive nerve endings at the cut ends. There is formation of clubbing at the cut ends thereby increasing the surface area of the cut end of the sensory nerves casing such type of pain. Muscular activities will cause shearing of such ends causing typical pain.
The possible remedies are:
Please discuss with your Doctor or a Neurologist to get a prescription of the following medicines that may help in such pains: Amitriptyline/ Carbamazepine/ Pregabaline/ Gabapentine - need a valid prescription, adjustment of the dosages to suit you and have good control of pain. I am most hopeful that one of these medicines helps you a lot.
Another way is to take help of the pain management clinical preferably run by an Anesthetist as he can test for the exact location of pain by giving local anesthesia and if the point can be pin-pointed can do a chemical neurectomy or the Surgeon explores the area to find the nerve end and cut out the causative clubbing.
I know this is very typical but can be found out and treated. Please take help of your Doctors and someone would do the needful and make life better.

If so, how would you know where to locate the location of the tear since many of these tissue injuries do not show up in scans?
Tear can cause pain only due to fibrosis now after such a long time. Yes, even the nerve can be entrapped into the fibrotic band that will always develop secondary to the healing in any case. The treatment remains same as discussed above.

I hope this answer helps you to get a proper diagnosis and have management to cure your pain.
Please get these things done and give feedback.
With warm regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (14 hours later)
I have read in great detail your responses to my questions. I do have several more questions: 1) Can the creation of fibrosis (formation of excess fibrous connective tissue) at an injury or surgical site completely or partially prevent the normal function of an individual or related muscle group in the lower abdominal muscles? When I have a "flare up" from walking too fast, walking up stairs or using an impact force tool (hammer, axe, etc.), the muscle or muscle group becomes very tight, does not stretch and feels that it is "locked in place" (with associated pain). The same occurs after orgasm during sexual intercourse. It can take weeks for the affected muscle / muscle group to relax and stretch even with the use of prescribed Klonopin used solely as a muscle relaxor; 2) Would the surgical placement of the latest design tension-free mesh be of any value placed over +/or under the suspected injury site to give support to this area?; 3) Would in your experience, consider this condition to heal itself over time provided that a re-injury did not occur?
doctor
Answered by Dr. T Chandrakant (51 minutes later)
Brief Answer:
As detailed below.

Detailed Answer:
To answer your further queries:
- Fibrosis can cause partial limitation of function, pain in lower abdominal muscle/s. Since it is taking weeks for flare up to settle there is a chance of associated fibromyalgia as many activities as you have mentioned are causing tightness - a sort of locked-in-place with pain. Klonopin acts as a good muscle relaxer but has no anti-inflammatory activity.
You may need further medications like NSAID like Ibuprofen or Diclofenac. Oral steroids of short course in reducing/tapering dosages should help during flare up - if you are not diabetic.
- Mesh would not help in any way as there is no hernia and will cause more fibrosis hence should not be used unless there is hernia.
- If a re-injury does not occur, healing will be good. But as you may know the abdominal muscles are always in work unless one is sleeping quietly or takes utmost care.

I hope this answers your queries.
Please feel free to ask for further relevant queries if you feel that there is a gap of communication.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 14771 Questions

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Can Hernia Occur Without An Opening In The Abdominal Wall?

Brief Answer: Nerve entrapment or clubbing at cut ends as explained in details. Detailed Answer: Hi. Thanks for your review query. Noted the previous discussion and the present history in detail. To answer your questions with explanations and possible remedies: -Can there be a hernia without an opening in the abdominal wall? The basic diagnostic feature of hernia is an opening into the abdominal wall that allows the abdominal contents to escape through to form a sac outside of its normal territory is called hernia. Hence is no opening there is no hernia. (although in rare cases like large muscles like that of thigh and calf there can be herniation of muscles though its capsule) -Can this extreme and debilitating pain be due to a muscle / tendon tear and can this be repaired? There is a possible remedy for such pain: Since there is tearing and burning pain the most probable cause is oversensitive nerve endings at the cut ends. There is formation of clubbing at the cut ends thereby increasing the surface area of the cut end of the sensory nerves casing such type of pain. Muscular activities will cause shearing of such ends causing typical pain. The possible remedies are: Please discuss with your Doctor or a Neurologist to get a prescription of the following medicines that may help in such pains: Amitriptyline/ Carbamazepine/ Pregabaline/ Gabapentine - need a valid prescription, adjustment of the dosages to suit you and have good control of pain. I am most hopeful that one of these medicines helps you a lot. Another way is to take help of the pain management clinical preferably run by an Anesthetist as he can test for the exact location of pain by giving local anesthesia and if the point can be pin-pointed can do a chemical neurectomy or the Surgeon explores the area to find the nerve end and cut out the causative clubbing. I know this is very typical but can be found out and treated. Please take help of your Doctors and someone would do the needful and make life better. If so, how would you know where to locate the location of the tear since many of these tissue injuries do not show up in scans? Tear can cause pain only due to fibrosis now after such a long time. Yes, even the nerve can be entrapped into the fibrotic band that will always develop secondary to the healing in any case. The treatment remains same as discussed above. I hope this answer helps you to get a proper diagnosis and have management to cure your pain. Please get these things done and give feedback. With warm regards.