Reduction en masse in a direct inguinal hernia presenting as intestinal obstruction: A case report with literature review

Inguinal hernias are very common in surgical practice. They are broadly subdivided into indirect and direct hernias on the basis of their entry into the inguinal canal. While indirect hernia have narrow neck, direct hernia are broad necked, therefore incidence of obstruction and strangulation is rare in direct hernia. A rare complication of hernia is “Reduction en masse” which is reduction or migration of a hernial sac into the preperitoneal space. It presents as persistent pain, obstruction or perforation even after disappearance of hernia. In this article we describe a case of reduction en masse hernia and its management along with literature review. As the complications can be fatal, it is important to keep this rare entity as a differential diagnosis while managing patients of acute abdomen.