An Unforeseen Cause Of Lower Abdominal And Groin Pain In A Male Recreational Athlete - Page #4

Working Diagnosis:
Sports-related abdominal hernia/internal fascial plane defect

The patient initially underwent conservative treatment for athletic pubalgia consisting of a short course of oral steroids, physical therapy for core and pelvic stabilization, cryotherapy, NSAIDs, and activity modification. He returned six weeks later with little improvement of his pain. Abdominal ultrasound was ordered at that time (see images). The patient was referred to general surgery and underwent laparoscopic transabdominal preperitoneal repair of right sided indirect inguinal hernia with cord lipoma. During the surgical procedure, an indirect inguinal hernia was identified on the left side. Both hernias were reduced during surgery and bilateral mesh implants were placed.

The patient followed up with general surgery one week and again at three weeks after his surgery. The patient's initial postoperative recovery was complicated by pain and swelling. This was initially managed with pain medication and cryotherapy. These symptoms eventually subsided and the patient was able to transition back to his normal daily activity. He continued to participate in physical therapy and a home exercise program. He was able to gradually return to his previous sport related activity and has not had any further complications.

Editor's Comments:
The workup of groin/ pelvic pain in athletes is difficult and diagnostic tests do not always produce a definitive diagnosis. These authors were fortunate that ultrasound yielded a clearer diagnosis than is typical.

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