CASE REPORT Laparoscopic Transabdominal Preperitoneal Hernioplasty for Reduction En Masse of an Incarcerated Inguinal Hernia: A Case Report Chin-Chia Wu & Jung-Cheng Kang & Yu-Min Huang Received: 16 January 2012 / Accepted: 10 February 2012 / Published online: 1 March 2012 # 2012 The Society for Surgery of the Alimentary Tract Abstract Introduction Reduction en masse is a rare complication of an incarcerated inguinal hernia. Its occurrence should be suspected when intestinal obstruction persists despite a seemingly successful manual reduction or hernioplasty. Case Report We report our experience in the management of a reduction en masse of a direct inguinal hernia. The diagnosis was established by computed tomography of the abdomen. The reduction en masse, as well as an accompanying indirect hernia, was successfully managed with laparoscopic transabdominal preperitoneal hernioplasty. Conclusion The safety, effectiveness, and minimal invasiveness conferred by the laparoscopic approach justified its application under such conditions. Introduction Reduction en masse is a rare complication of an incarcerated inguinal hernia, occurring in approximately 1 of 13,000 hernias. 1 It arises when the incarcerated sac is reduced into the properitoneal space with forcible manipulation or during the operation. The intestinal loop remains trapped in the sac, however, and obstruction persists. 1–3 If left unrecognized and untreated, strangulation may develop and result in significant morbidity and mortality. 4 We report our experience in the management of a reduction en masse of a direct inguinal hernia, where a laparoscopic transabdominal preperitoneal (TAPP) hernioplasty successfully treated the patient. Case Report An 85-year-old man presented with an irreducible lump over his left groin for several hours. The lump had been noted for about 1.5 years and was reducible to manip- ulation previously. He had a history of stroke and was on prolonged warfarinization. In the emergency room, the lump was reduced with forcible manipulation. He refused further surgical intervention because of concerns about the risks associated with his age and underlying medical condition. Unfortunately, abdominal distension and pain occurred soon after discharge from our hospi- tal. He visited our emergency room again about 6 h later. On examination, his abdomen was soft but dis- tended. Tenderness was noted over the left lower abdomen, but there was no longer a lump over his left groin. Computed tomography showed a cyst-like lesion containing bowel loops over his left pelvis (Fig. 1a, b). Under the impression of a small bowel obstruction caused by reduction en masse of an inguinal hernia, a laparoscopic TAPP hernioplasty was performed. Under general anesthesia, an 11-mm trocar (Ethicon Endo-Surgery, USA) was inserted via a subumbilical minilaparotomy to create the pneumoperitoneum and for the C.-C. Wu : J.-C. Kang Division of Colorectal Surgery, Department of Surgery, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan Y.-M. Huang (*) Division of General Surgery, Department of Surgery, Buddhist Tzu Chi General Hospital and Tzu Chi University, No. 707, Sec. 3, Zhongyang Rd., Hualien 97002, Taiwan e-mail: y.m.huang@yahoo.com.tw J Gastrointest Surg (2012) 16:1433–1435 DOI 10.1007/s11605-012-1846-1