%0 Journal Article
%T Late-Onset Bowel Strangulation due to Reduction En Masse of Inguinal Hernia
%A Ikuo Watanobe
%A Noritoshi Yoshida
%A Shin Watanabe
%A Toshirou Maruyama
%A Atsushi Ihara
%A Kuniaki Kojima
%J Case Reports in Surgery
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/295686
%X Incarcerated inguinal hernia is often encountered by surgeons in daily practice. Although rare, hernial reduction en masse is a potential complication of manual reduction of an incarcerated hernia. Manual reduction was performed in a case of Zollinger classification type VII (combined type) hernia in which the indirect hernia portion included an incarcerated small intestine. This procedure caused hernial reduction en masse, but this went unnoticed, and the remaining portion of the direct hernia in the inguinal region was treated surgically by the anterior approach. Because the incarcerated small bowel that had been reduced en masse was not completely obstructed, the patient¡¯s general condition was not greatly affected, and he was able to resume eating. Twenty days after surgery, he developed sudden abdominal pain as a result of gastrointestinal perforation. When performing manual reduction of an incarcerated hernia in cases after self-reduction over a long period, the clinician should always be aware of the possibility of reduction en masse. 1. Introduction Hernial reduction en masse is a rare condition in which the hernial sac is returned to the properitoneal space along with incarcerated bowel during reduction. It can be defined as reduction of the hernia sac together with its intestinal contents so that the bowel still remains incarcerated. This condition requires surgical reduction and treatment to release strangulation. A case of small bowel perforation following reduction en masse that went unnoticed when a recurrent left inguinal hernia was manually reduced is reported. 2. Case Presentation The patient was a 75-year-old man. He had undergone surgery for a left inguinal hernia 23 years earlier, but the details were unknown. Four years earlier, the left inguinal hernia recurred and underwent repeated prolapse, spontaneous rectification, and self-reduction. Since last year, the hernia occasionally became incarcerated. On each occasion, the patient was treated by manual reduction as an outpatient, but he did not wish to undergo surgery, and the situation continued as it was. Over the previous month, the hernia frequently became incarcerated, and the patient visited our hospital as usual for manual reduction of the incarceration. This time the patient agreed to surgery and was admitted and treated surgically on the same day. Physical findings were as follows: height 170£¿cm, weight 70£¿kg, and temperature 36.6¡ãC. The left lower abdomen was slightly tender, but there were no symptoms of peritoneal irritation such as rebound tenderness or guarding. After
%U http://www.hindawi.com/journals/cris/2014/295686/