A Case of Reduction en Masse of an Inguinal Hernia Diagnosed Preoperatively and Treated by Laparoscopic Surgery

Abstract

The patient was a 77-year-old man with a 10-year history of right inguinal hernia, and he had repeatedly reduced the hernia by himself until the morning of the day when he was eventually referred to our hospital. Around the noon of the day, he developed abdominal distension, abdominal pain and vomiting and visited a neighboring hospital. Since an abdominal plain x-ray revealed small bowel dilatation and air-fluid level, he was referred to our hospital with a diagnosis of intestinal obstruction. An abdominal CT scan showed a cystic structure at the right lower quadrant which continued from the parietal peritoneum and contained ascites and an edematous bowel loop inside. We diagnosed the case as intestinal obstruction due to reduction en masse of the inguinal hernia and performed emergency laparoscopic surgery on the same day. Operative findings showed that the small bowel loop was impacted in the pre-peritoneal space with the bowel loop remaining incarcerated into the hernia sac. Reduction was easily done by tugging with a clamp. No apparent necrosis was encountered in the small bowel, so that laparoscopic hernia repair was performed by using a mesh.

Reduction en masse of the inguinal hernia is a comparatively rare disease where the prolapsed organ is reduced into the pre-peritoneal space remaining incarcerated into the hernia sac. Thorough questioning and imaging diagnoses may afford to make preoperative diagnosis. Laparoscopic surgery that can promise less invasiveness and definite diagnosis and treatment appears beneficial.