2026 Volume 62 Issue 1 Pages 79-84
We report a very rare pediatric case of reduction en masse (REM) of an inguinal hernia diagnosed preoperatively by ultrasonography. The patient was a 1-year-old boy who had undergone manual reduction for a right incarcerated inguinal hernia at a previous hospital. Despite the manual reduction, vomiting persisted, and he was transferred to our hospital for further evaluation and treatment. Physical examination revealed no swelling in the inguinal region, but a right undescended testis was noted. On the basis of his medical history and ultrasonographic findings, a diagnosis of REM was made. Emergency laparoscopic surgery was performed on the same day, and the incarcerated terminal ileum was preserved. The morphology of the hernial orifice led to a diagnosis of REM of a de novo external inguinal hernia. Owing to a marked thickening of the peritoneum and difficulty in identifying the vas deferens and testicular vessels, the initial surgery involved simple closure of the hernial orifice. A staged surgical approach was adopted, planning the subsequent high ligation of the internal inguinal ring and orchiopexy. The patient’s postoperative course was uneventful, and the second-stage surgery was carried out four months later via an inguinal approach. REM should be considered as a complication following the manual reduction of incarcerated inguinal hernias, although it remains uncommon in pediatric patients. Abdominal ultrasonography proved highly useful for accurate diagnosis in this case.
