A 45-year-old man with a long-standing right inguinal hernia attempts vigorous self-reduction at home. The swelling disappears, but over the next few hours he develops increasing abdominal distension, vomiting, and generalized abdominal tenderness with rigidity. The most likely explanation is:

• A Spontaneous resolution with postoperative ileus
• B Reduction en masse of the hernia into the peritoneal cavity with continuing obstruction ✓
• C Rupture of the hernial sac into the scrotum
• D Conversion of an indirect into a direct hernia

Explanation

Reduction en masse occurs when the whole sac together with its obstructed contents is forced back into the abdomen, usually through a narrow neck. The hernia appears reduced, but the strangulating or obstructing mechanism persists inside the peritoneal cavity, so the patient deteriorates with distension and peritonism. This is precisely why forceful taxis is condemned in modern practice, especially when the hernia is tender or recently irreducible.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.