A case of false reduction of an inguinal hernia by self-repositioning

Abstract

The patient was a 74-year-old man who repeatedly repositioned his inguinal hernia. He was examined by a local physician with a chief complaint of vomiting and was referred to our hospital for further examination and treatment. At the time of initial examination, only distension of the abdomen was observed, with no swelling in the right inguinal area, rebound tenderness or muscle guarding. Abdominal X-ray revealed marked small intestinal gas, and abdominal computed tomography (CT) scanning showed spherical dilation of the small intestine in the lower right abdomen. Ileus was diagnosed, but as there were few abdominal findings and no distension of the right inguinal area, treatment by fasting and long tube insertion was started. As decompression was ineffective and the same findings were again observed on a further abdominal CT scan, surgery was performed. Part of the small intestine had protruded through the deep inguinal ring and was trapped in the anterior peritoneal cavity, resulting in ileus due to the false reduction of a right inguinal hernia. The intestine was repositioned using the water pressure method ; however, the incarcerated portion of the small intestine was resected due to concern regarding impaired blood flow to the strangulated area. The patient's postoperative course was favorable, and the patient was discharged from hospital 14 days postoperatively. False reduction of an inguinal hernia is extremely rare. This report includes a short discussion of the literature.