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Reduction en masse of inguinal hernia after self-reduction: a case report
Khosrow Najjari1, Hossein Zabihi Mahmoudabadi2, Seyed Zeynab Seyedjavadeyn1
1Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Imam Khomeini St., Tehran, Iran.
Background:
Reduction en mass (REM) is one of the rare complications of inguinal hernia reduction. Although REM can be detected on the basis of specific computed tomography (CT) scan findings, many radiologists are not familiar with its radiological appearance because of the scarcity of this complication, which may cause a delay in diagnosis.
Case Presentation:
The patient reported in this article was a 50-year-old Persian man with a history of inguinal hernia, who had been referred with the periumbilical pain that radiated to the right lower quadrant and developed following hernia replacement by the patient himself. REM diagnosis was based on clinical examination and CT scan findings, and surgical treatment was performed by the Lichtenstein repair and mesh implantation.
Conclusions:
Although REM usually occurs after reduction with compression in the inguinal hernia, this unique case report highlighted the possibility of REM after self-reduction. Surgeons and radiologists should consider REM in patients with a history of inguinal hernia presenting with intestinal obstruction symptoms, even without any apparent signs of hernia in the physical examination.
Insights
Reduction en mass (REM) is a rare complication of inguinal hernia repair. This case highlights REM occurring after self-reduction, emphasizing the need for vigilance in diagnosing intestinal obstruction in hernia patients.
Area of Science:
- Medical imaging and radiology
- Surgical complications
- Gastrointestinal surgery
Background:
- Reduction en mass (REM) is a rare complication following inguinal hernia reduction.
- Familiarity with REM's radiological appearance is limited among radiologists due to its scarcity, potentially delaying diagnosis.
Observation:
- A 50-year-old male with a history of inguinal hernia presented with periumbilical pain radiating to the right lower quadrant after self-reduction of the hernia.
- Clinical examination and computed tomography (CT) scan findings confirmed the diagnosis of REM.
- The patient underwent surgical repair using the Lichtenstein technique with mesh implantation.
Findings:
- This case demonstrates REM occurring subsequent to self-reduction, a scenario distinct from the typical post-compression reduction.
- Computed tomography (CT) is crucial for identifying the characteristic radiological signs of REM.
Implications:
- Radiologists and surgeons should consider REM in patients with a history of inguinal hernia presenting with symptoms of intestinal obstruction, even without overt physical signs of hernia.
- Early recognition and diagnosis of REM are critical to prevent delayed treatment and potential complications.
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