A Case of Reduction en Masse of Inguinal Hernia

Abstract

A 75-year-old man was admitted to the hospital with intestinal obstruction following manual reduction of an incarcerated right inguinal hernia. As the intestinal obstruction persisted despite insertion of a long intestinal tube, the patient was transported to our hospital 5 days after the reduction, for an operation. Abdominal CT showed the properitoneal hernial sac sign without poor contrast of the intestinal wall. We diagnosed the condition as reduction en masse of the inguinal hernia and performed an emergency operation. At laparotomy, we observed that the incarcerated small bowel had been reduced together with the entire hernial sac into the preperitoneal space. We reduced the small intestine without enterectomy and performed mesh repair of the inguinal hernia via an anterior approach. The hernia was diagnosed as type M1, according to the Japanese Hernia Society classification. Reduction en masse of inguinal hernia is simple to diagnose by visualization of the properitoneal hernial sac sign on CT images. Therefore, CT examination should be performed in patients presenting with persistent intestinal obstruction after hernia reduction. Although rare, early operation is crucial to release the bowel from incarceration.