Abstract
The case of a 59-year-old man who had been diagnosed with right inguinal hernia and had frequently experienced protrusion in the right inguinal area but managed to reduce the hernia by himself each time is described. In late October, 2008, the patient manually reduced another hernia in the right inguinal area, but he subsequently developed abdominal pain that gradually worsened. Therefore, he visited a local physician the next day, was diagnosed as having ileus, and was referred to our hospital. On examination, no protrusion was observed in the right inguinal area, and although spontaneous pain and tenderness were present in the lower abdomen, no peritoneal irritation was seen. Abdominal plain X-ray showed dilation of the small intestine, and abdominal CT showed dilation of the intestinal tract in the right lower quadrant, but no prolapse of organs outside the abdominal wall in the right inguinal area was observed. The patient was treated conservatively, but since the ileus appeared to worsen on abdominal plain X-ray the next day, conditions such as internal hernia and strangulation by bands were suspected, and emergency laparotomy was performed. Examination of the abdominal cavity revealed a hernia sac that invaginated into the abdominal cavity side in the right inguinal area, in which the small intestine was incarcerated. This is a rare type of incarceration called reduction en masse.
