|
General Surgery
General surgeons see several patients with chronic pain mimicking chronic diverticulitis, prostatitis, and
epididymoorchitis. Patients may also present with post inguinal herniorrhaphy pain or simply idiopathic pain.
Amongst females on detailed questioning nearly 70% had dyspareunia some had rectal pain, some had bladder symptoms, some had gluteal and coccygeal pain. All of the above suggest pelvic pathology. Another interesting subset that general surgeons see are patients with undiagnosed rectal pain, pain over ischial tuberosities (sitting bones) and coccygeal pain (coccydynia). Also patients with non-bacterial prostatitis and interstitial cystitis are also seen. Another commonly discussed topic amongst general surgeons is groin pain following repair of groin hernias. Typically after the initial incisional pain subsides, usually within 2-3 weeks, depending on the techniques used, there is a short pain-free interval of 1 to 4 weeks. Pain of POPSS syndrome starts after 4-6 weeks postoperatively.
 Rutkow noticed chronic groin pain in 102 patients out of 1,442 groin surgeries he performed over 3 years. More importantly they observed that 99 out of 102 patients had pain in the groin prior to herniorrhaphy. The majority of
these patients continue to have persisting groin pain after the surgery. Our observations have been similar and we feel that pain in the groin associated with - clinically documented groin hernia during a preoperative visit is usually due to enthesopathy and, in fact, I give steroid injections during the repair and also repeat one or 2 more injections 2 weeks apart during the postoperative follow-up.
Rutkow discounts nerve entrapment theory on the grounds that 99 of 102 post hernia groin pain patients had preoperative pain in the groin. In our series all patients with postoperative groin pain were treated as enthesopathy/periosteitis with steroid injections and we had 89% excellent to good results. (See attached article for details)
| 
