Abstract
An 86-year-old man was seen at the hospital because of a right inguinal mass on January 23, 2009, when he had no incarceration and symptoms suggestive of intestinal obstruction. Thus elective surgery was scheduled, but the patient was seen at the hospital again because of upper abdominal pain on January 27, 2009. Abdominal plain X-ray film showed niveau formation. An abdominal pelvic CT scan revealed an incarcerated intestine in the right inguinal region and whirl sign in the upper abdomen. Secondary small intestinal volvulus due to right incarcerated inguinal hernia was suspected, and emergent laparoscopic-assisted surgery was performed on the same day. At surgery, we confirmed the wholly dilated small intestine in the abdominal cavity, and Richter type right incarcerated inguinal hernia of the terminal ileum. The incarcerated intestine was repositioned into the abdominal cavity by using forceps. There were no ischemic changes in the incarcerated intestine. Further exploration disclosed volvulus twisted counterclockwise by about 720 degree around the superior mesenteric vein as the axis, and repositioning of the intestine was done. No ischemic changes were seen in the involved small intestine and thus intestinal resection was not demanded. Radical repair for the right inguinal hernia was made by using the Mesh plug method and the operation was finished. The patient's postoperative course was uneventful and he was discharged from the hospital on the 17th postoperative day.
