Reduction en Masse of an Inguinal Hernia Treated with a Laparoscopic Composite Operation

Abstract

A 59-year-old man was referred to our hospital because of left-sided inguinal pain. He was diagnosed with an incarcerated inguinal hernia, which was manually reduced. Several hours after the reduction, he returned to our hospital with abdominal pain and vomiting. No herniation was observed in the inguinal region. Abdominal computed tomography revealed a round mass containing a part of the small intestine and fluid close to the left inguinal region. He was diagnosed with bowel obstruction secondary to reduction en masse (REM) of an inguinal hernia and underwent emergency surgery. We utilized a front approach from the groin. He showed evidence of coexistence of indirect and direct hernia, and we performed hernia repair using a Modified Kugel Patch®. We performed laparoscopy to examine the abdominal cavity because we were not able to confirm the presence of REM in the operative field using the anterior approach. The thickened peritoneum served as the hernial orifice and strangulated the small intestine. Intestinal blood flow improved as soon as we loosened the hernial orifice ; thus, the small intestine could be preserved. After surgery, the patient was discharged following an uneventful course. We propose that a laparoscopic composite operation facilitates detailed examination and is useful in patients presenting with REM.