Is TU infraumbilical bds. due to abdominal hernia?
April 12, 2017 | 50,00 EUR | answered by MD Felix Aaslepp
Dear Madam or Sir,
Due to a lack of available resources of surgeons in my region, I would like to briefly describe my problem here and request an initial assessment based on my information.
Regarding my problem: After experiencing unspecific pressure/discomfort in my lower abdomen a week ago, I palpated my abdomen. To my shock, I found several smaller nodules.
The most prominent nodule is located on the left side, vertically about 5 cm above the inguinal ligament and horizontally about 5 cm next to the linea alba. The nodule is slightly movable and rather firm. Due to the layers of skin above, it is difficult for me to estimate the size. I would estimate it to be about 0.5 - 1 cm with a slightly oval shape.
Furthermore, there are two nodules about 5 cm below the belly button, symmetrically at a horizontal distance of about 5 cm. These nodules feel slightly smaller and firmer. Approximately the size of a grape seed.
The nodules are not painful to touch.
Due to the persistent, tendentially worsening unspecific pressure sensation in the abdomen, I visited a general practitioner today. He palpated the nodules and tested the reaction to a cough reflex. His verbal suspicion is an abdominal wall hernia, and I should have it further clarified by a surgeon. The diagnosis on the referral slip is "TU infraumbilical bds." Furthermore, a full blood count has been ordered, and I will receive the results tomorrow.
Based on my knowledge of hernias, I find it somewhat difficult to accept the diagnosis. As far as I know, a hernia forms a larger hernia sac, but in my case, there are several smaller ones. Additionally, the hernia sac typically forms in common areas such as the belly button, inguinal region, etc., but infraumbilical only in the presence of a previous surgical scar.
Are my assessments incorrect? If so, please explain, particularly how the small nodules in this case are related.
If not, what could be an alternative possible diagnosis?
I am most concerned about this "vague" feeling in my abdomen. Occasionally, there is also a slight pulling sensation into the left testicle, as well as a pulling sensation into the hips. Is this in the case of an actual hernia already an early sign of incarceration? Or rather a symptom of another diagnosis?
Additional information/pre-existing conditions:
- As an infant, a right-sided inguinal hernia was surgically corrected.
- Have had tense abdominal muscles permanently for about a year.
I look forward to your prompt and competent response.
Sincerely, [Your Name]
Hello,
I have two small follow-up questions for you:
Could you kindly tell me your age? How do your abdominal muscles, which have been consistently tense for a year, manifest themselves? Do you train them extensively or do you mean muscle tension that you do not intentionally bring about?
Now to your complaints:
While hernias occur more frequently at certain "weak points" of the body - e.g. belly button, groin, surgical scars - there are also abdominal wall hernias/ruptures that occur without a previous surgery. In this case, a hernia develops when layers of the abdominal wall muscles are pushed apart. This can be exacerbated by connective tissue weakness, chronically increased pressure in the abdominal cavity, and similar factors. Occasionally, multiple abdominal wall hernias can occur in parallel - this is rare but possible. In this context, I am particularly interested in your description of the consistently tense abdominal muscles. Do the lumps recede when lying down or are they more prominent when standing? For a hernia, it would be typical if you could gently massage/push them away while lying down (do not use force). Since you describe that the palpable lumps are not tender to touch, it is possible that they are hernia sacs containing fatty tissue and possibly peritoneum. At a size of about 1 cm, it is highly unlikely that the intestine can protrude into the hernia sac and lead to a strangulation/incarceration of the intestine, but a strangulation of the peritoneum could occur. You would notice such strangulation through severe pain and should immediately go to the emergency room of the nearest hospital in that case.
Another explanation - especially if the lumps are still present when lying down - could be lipomas. These are benign fatty tissue tumors that can have various shapes and consistencies. In this case, it would only be a cosmetic issue and would not require treatment.
These are the two most likely causes, which can only be confirmed through a physical examination by a surgeon, possibly with an additional ultrasound examination. Of course, there are also various less likely/rare causes, but malignant tumors or metastases in the abdominal wall or fatty tissue are rather rare.
Now, regarding your rather nonspecific abdominal complaints: If they are due to abdominal wall hernias, the symptoms including pulling into the groin/testicles could be caused by irritation of the peritoneum. Another explanation could be functional complaints independent of the palpable lumps, for example due to the problem of consistently tense abdominal muscles and also due to stress/psychological factors. Especially now that you know there is something there that does not belong, you may quickly notice increased symptoms or they may be amplified by stress.
Ultimately, you should see a surgeon for an evaluation as soon as possible to receive a definitive diagnosis. If the complaints are due to abdominal wall hernias, it is recommended to undergo surgical closure to alleviate the symptoms and prevent possible strangulation. These are relatively minor procedures nowadays.
If your symptoms worsen, you can always seek an evaluation in the nearest emergency room by the on-call surgeon as an acute patient.
I wish you a prompt definitive diagnosis and a speedy recovery!
