Transabdominal Preperitoneal Approach for Reduction en Masse of Inguinal Hernia—A Case Report—

Abstract

A 60-year-old man was referred to our hospital with right inguinal swelling and pain. Abdominal computed tomography (CT) revealed an incarcerated right inguinal hernia with dilatation of the small bowel proximal to the hernia. We could successfully manually reduce the right inguinal protrusion, and the inguinal hernia disappeared into the inguinal region. The patient was admitted to our department for follow-up. He developed nausea and vomiting, 4 days after admission and underwent repeat CT, which revealed small intestinal strangulation at the preperitoneal space of the right inguinal region ; therefore, we diagnosed the patient with reduction en masse. We performed decompression of the dilated small bowel using along intestinal tube, followed by transabdominal preperitoneal repair (TAPP). Intra operatively, we observed strangulation of the small intestine with peritoneal thickening as the hernial orifice. We released the hernial orifice and performed hernia repair using a mesh because we did not detect any intestinal necrosis. Reduction en masse is a rare entity in which the inguinal hernia sac prolapses into the preperitoneal space along with the incarcerated bowel. It is difficult to diagnose this condition using an anterior approach ; however, TAPP is useful for the diagnosis and repair of reduction en masse.