Reduction en masse can be treated using pure laparoscopic transabdominal preperitoneal hernioplasty following early CT diagnosis: report of a case.

Abstract

Reduction en masse refers to the rare occurrence of an incarcerated inguinal hernia arising from the manual reduction of a hernia. Such a condition constitutes a medical emergency because the hernia contents, such as the small bowel, remain strangulated in the preperitoneal space. Therefore, an early and accurate diagnosis, with early treatment, is important. A 61-year-old Japanese man presented with an irreducible lump over his left groin, leading to the reduction of an incarcerated inguinal hernia by a doctor at another hospital. Later, he was admitted to our hospital with vomiting and abdominal pain. Computed tomography showed a ball-like lesion containing an incarcerated bowel loop over his left pelvis. The patient was diagnosed with an incarcerated small bowel obstruction due to a reduction en masse; a laparoscopic transabdominal preperitoneal (TAPP) hernioplasty was performed. TAPP hernioplasty is a safe method for treating reductions en masse that allows confirmation of bowel viability.