An often-encountered injury in the workers’ compensation setting is an abdominal hernia. In most instances, the employer and its counsel will attempt to downplay the significance of an abdominal hernia injury, categorizing it as a common and minor injury. The focus of this article is to dispel the notion that the majority of the time an abdominal hernia is a minor injury.
It is well established that an abdominal hernia can come from heavy lifting. Consequently, if the defense medical examiner agrees that the claimant is suffering from an abdominal hernia, the defense medical examiner will then usually agree that the injury was work-related as long as the history provided by the claimant otherwise appears consistent.
As a result, the defense in an abdominal injury case will generally focus not around causation, as is many times the circumstance in a workers’ compensation case; rather, the defense will focus on the severity of the injury. The defense medical examiner will generally testify that the claimant should have returned to work within weeks or months of the original diagnosis and treatment with little or no restrictions on work activities.
In order to better understand the typical arguments presented by the defendant in a hernia case, it is important to start with the injury itself.
The term hernia merely means the protrusion of an organ through the wall of the cavity that normally contains it. In an abdominal hernia, the hernia material pushes through the abdominal wall, forming a protrusion. The protrusion can be detected in the clinical setting on palpation by the examining physician. Abdominal hernias can also be detected on diagnostic testing such as an MRI. Within abdominal hernias are subcategories of hernias. By far the most common hernia (up to 75 percent of all abdominal hernias) are inguinal hernias. Inguinal hernias are when the hernia contents push through a weak spot in the back wall of the inguinal canal. Inguinal hernias are the most common type of hernia in both men and women and they often require surgery.
Although all physicians can make the diagnosis of an inguinal hernia, the physician most qualified to treat an inguinal hernia is a general internist/general surgeon. Generally speaking, the treating physician will first attempt to treat the hernia by pushing it back into place. Admittedly, in my experience, when the treating physician can treat the hernia merely by pushing it back into place, it generally will not result in significant side effects. The significant side effects occur when the hernia requires hernia repair surgery. Hernia repair refers to a surgical operation for the correction of a hernia.
There are generally two types of surgery to repair an inguinal hernia, known generically as an open repair and laparoscopic repair. Both types involve the use of mesh to control the herniated material, so to speak. The open repair is used more often because it involves less instance of recurrence. However, it also carries more complications (for obvious reasons given its open nature). Some of the more minor complications can include abcess, fistula or bowel obstruction. However, there are also major complications from either type of hernia repair.
From a personal injury standpoint, the claimant’s attorney needs to be aware of a condition called chronic groin pain, which can develop after a hernia injury, and a condition called ilioinguinal neuralgia.
Chronic groin pain is a potentially disabling condition that can be accompanied by neuralgia, paresthesia (numbness), hypoesthesia and hyperesthesia (increased sensitivity). It is well established that chronic groin pain causes an inability to work and perform physical and social activities. It is also known to cause sleep disturbances and psychological distress.
Ilioinguinal neuralgia is a condition that occurs secondary to inguinal hernia repair. Ilioinguinal neuralgia is essentially neuropathic pain. Neuropathic pain is defined as pain in the sensory distribution of an offended nerve. Ilioinguinal neuralgia can cause chronic and debilitating pain. It is most often due to destruction or entrapment of nerve tissue from staples, sutures or direct surgical trauma. The claimant’s attorney must be aware that ilioinguinal neuralgia is a generic term that can refer to an entrapment of any of the three nerves that escape the inguinal canal, including the ilioinguinal nerve, the iliohypogastric nerve or the genitofemoral nerve.
Treatment for ilioinguinal neuralgia includes oral analgesics, nerve blocks, mesh excision and surgical neurectomy. These treatments have varied success rates and may still leave the claimant suffering from the condition. In other words, the condition may be irreversible. In any event, all physicians will agree that ilioinguinal neuralgia is challenging to treat and can cause high levels of pain and disability.
In my small amount of space I have tried to dispel the notion of an abdominal hernia as a small or routine injury. Each of the issues I raised is discussed in detail in medical literature and is readily available for the personal injury attorney to access with proper research.■