A Case of Reduction en Masse of an Obturator Hernia

Abstract

Reduction en masse of a hernia is a rare condition where a prolapsed organ is retracted into the preperitoneal space while remaining trapped within the hernia sac. This complication has been documented following the reduction of incarcerated inguinal or femoral hernias. Obturator hernias themselves are uncommon, and cases of reduction en masse within this type of hernia have yet to be reported. We present a case of a patient with a reduced en masse of obturator hernia. An 85-year-old woman diagnosed with a left incarcerated obturator hernia via computed tomography (CT) underwent ultrasound-guided reduction and was subsequently hospitalized. On the third hospital day, she developed intestinal obstruction necessitating exploratory laparotomy due to a lack of improvement. Intraoperatively, the herniated small intestine was found to be reduced into the preperitoneal cavity through the obturator foramen, remaining incarcerated within the hernia sac, consistent with a diagnosis of reduction en masse. The surgical approach included small bowel resection, inversion and ligation of the hernia sac, followed by laparoscopic radical hernia repair at a later date. Retrospective CT imaging of post-reduction identified a preperitoneal hernial sac sign, a characteristic finding of reduction en masse. Our case highlights the potential for incarcerated obturator hernias to undergo reduction en masse after initial reduction. Therefore, post-reduction CT imaging is crucial to confirm the absence of this life-threatening complication.