Right groin pain after tissue repair

The patient is a 73-year-old male, status post classic Shouldice repair of his right inguinal hernia 3 months earlier. Preoperatively he had a bulging hernia with scrotal extension, without significant pain. He now complains of daily groin pain, 7/10, ranging from 2/10 to 9/10. This began 3 weeks postoperatively after an otherwise uneventful early recovery period when he was feeling “amazing.” He now reports a feeling of tightness, like a “rubber band” across his lower abdomen at the level of the repair. He feels like he wants to “pop out.” The pain is at times burning, sharp, shooting, or a dull constant pain at baseline. The pain radiates to the upper inner thigh as a “minor but irritating” burning stinging pain. The pain also radiates to his flank and he feels pain at his hip bone. He denies testicular pain. He has swelling of the right groin that comes and goes. He also has bloating and feels “filled with gas.” He has changed his diet, removed all dairy, and takes daily probiotics, stool softeners, and anti-gas medication, with no improvement. He denies constipation or straining.

The patient gets up from sitting position with mild distress. His entire lower abdomen seems a bit edematous and bloated. The right groin has a healed incision and is edematous along the wound and its periphery. He is 2+ tender along the entire groin area, nonspecifically. There is no palpable mass or hernia recurrence. He has no hypesthesia or allodynia in the region.