Two cases of reduction en masse of inguinal hernia

Abstract

A 76-year-old man presented with sudden lower abdominal pain and nausea. Abdominal CT scan revealed a dilated small intestine with poor enhancement of the intestinal wall in the right lower abdomen and a right scrotal hydrocele. Preoperative diagnosis was a strangulated bowel obstruction and a right scrotal hydrocele. Emergency operation was performed. Intraoperative diagnosis showed the reduction en masse of an inguinal hernia, since a hernia sac was seen between the abdominal wall and the preperitoneal space. The small intestine became strangulated in the right internal inguinal ring. Partial resection of the small intestine and plication of the hernia orifice were performed. The second patient was a 60-year-old man who presented with 8 hours of abdominal pain and vomiting and was transported by ambulance with persistent symptoms despite reduction of a right inguinal protrusion. Abdominal CT scan revealed a prominent small intestinal loop near the right inguinal region. Reduction en masse of a right inguinal hernia was diagnosed and emergency operation was performed. A definitive diagnosis of reduction en masse of inguinal hernia was made based on strangulated small intestine in the right internal inguinal ring and a hernia sac in the preperitoneal space. The small intestine was reduced without resection and the hernia was repaired using mesh in the preperitoneal space. We report two cases of reduction en masse of an inguinal hernia with a review of previous cases of reduction en masse in Japan and a brief review of the literature.