Strangulated Small Bowel Obstruction Caused by a Hernia-Related Adhesive Band after Successful Reduction of an Incarcerated Inguinal Hernia.

Abstract

Introduction: Incarcerated inguinal hernia is a common surgical emergency. Persistent bowel obstruction after successful reduction is typically attributed to reduction en masse, whereas other mechanisms of ongoing strangulation are rarely reported. We describe a rare case in which bowel strangulation persisted despite successful reduction of an incarcerated inguinal hernia due to a hernia-related adhesive band.

Case presentation: A 92-year-old man presented with an incarcerated left inguinal hernia. Manual reduction was successfully performed, and contrast-enhanced CT confirmed reduction of the herniated bowel into the abdominal cavity without obvious signs of ischemia or persistent incarceration. However, abdominal pain and small bowel obstruction persisted. Because ongoing strangulation could not be excluded, emergency laparoscopic exploration was undertaken. Intraoperatively, the incarcerated bowel had been completely reduced into the abdominal cavity, and no evidence of reduction en masse was identified. Instead, a fibrous band extending from the sigmoid colon to the retroperitoneum formed a constricting ring that entrapped a segment of small bowel, resulting in strangulated obstruction. Laparoscopic division of the band immediately relieved the strangulation, and bowel resection was avoided. Retrospective review of the post-reduction CT revealed subtle findings consistent with a closed-loop obstruction.

Conclusions: This case highlights that successful reduction of an incarcerated inguinal hernia does not necessarily indicate resolution of strangulation. Persistent symptoms after reduction should prompt consideration of ongoing bowel strangulation even when CT findings appear reassuring.