Abstract
Although reduction en masse (REM), in which incarcerated organs are returned to their normal site without relieving the strangulation, is very rarely encountered, it is an important event in hernia treatment. We examined a case of REM that was diagnosed and repaired by laparoscopic operation.
An 81-year-old-woman was admitted to our hospital with several hours of abdominal pain and vomiting. She had developed an incarcerated inguinal hernia, and manual reduction of the hernia was initially attempted with success. Several hours after the reduction, she underwent a repair surgery under spinal anesthesia. A direct hernia was found and repaired with the Prolene Hernia System without opening the hernia sac. Because the symptoms of intestinal obstruction did not improve after the operation, a CT scan and plain abdominal radiography were performed ; the imaging findings strongly indicated REM. An emergency laparoscopic operation was performed. Strangulation of the small intestine was confirmed, and it was successfully relieved. The patient recovered uneventfully after the second operation and was discharged. It is important to suspect REM when we encounter an incarcerated hernia as well as examine the hernia sac for strangulation during the operation. When laparoscopic surgery can be performed, it is useful for both the examination and treatment of REM.
