title: Late-Onset Bowel Strangulation due to Reduction En Masse of Inguinal Hernia.
abstract: 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.
authors.affiliation: Department of Surgery, Asakusa Hospital, 1-10-12 Higashiasakusa, Taitou-ku, Tokyo 111-0025, Japan ; Division of General Surgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-Ku, Tokyo 177-8521, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Watanobe
authors.affiliation: Department of Surgery, Asakusa Hospital, 1-10-12 Higashiasakusa, Taitou-ku, Tokyo 111-0025, Japan.
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Department of Surgery, Asakusa Hospital, 1-10-12 Higashiasakusa, Taitou-ku, Tokyo 111-0025, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, Asakusa Hospital, 1-10-12 Higashiasakusa, Taitou-ku, Tokyo 111-0025, Japan.
authors.forename: Toshirou
authors.initials: T
authors.lastname: Maruyama
authors.affiliation: Department of Surgery, Asakusa Hospital, 1-10-12 Higashiasakusa, Taitou-ku, Tokyo 111-0025, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ihara
authors.affiliation: Division of General Surgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-Ku, Tokyo 177-8521, Japan.
authors.forename: Kuniaki
authors.identifier: 0000-0003-1572-2519
authors.initials: K
authors.lastname: Kojima