Reduction en masse in a 7-year-old boy: an interesting case

Reduction en masse is a complication of inguinal hernia reduction in which a hernia is reduced back into the peritoneal cavity, but a loop of bowel remains trapped inside the hernia sac after reduction. Reduction en masse can be difficult to diagnose because of generalized and nonspecific symptoms. We describe a 7-year-old boy with an atypical presentation of reduction en masse after hernia reduction. The patient was a previously healthy child who presented with a mildly painful right inguinal mass of 1 day duration. An incarcerated hernia was noted, and after reduction, the pain dissipated for a short period, only to return with pain in the right lower quadrant and generalized peritoneal irritation. At surgical exploration, a reduction en masse was definitively diagnosed, and the incarcerated bowel was released from the hernia sac.