case_images: PMC10965298_01
case_images: (
  A
  ) After manual reduction of the hernia, the hernia bulge was not appreciable, but the left testis was raised to the proximal of the inguinal canal (arrow). (
  B
  ) Laparoscopy revealed a remarkably dilated intestine, serous ascites, and ischemic intestine at the left groin, which could not be retrieved to the surgical field. (
  C, D
  ) A lower midline laparotomy was performed, and the hernia sac with a loop of bowel remaining strangulated at the neck of the hernia sac in preperitoneal space was noted. Incision of the thickened neck of the hernia sac, resection of the strangulated ileum, approximately 2 cm before the ileocecal valve, and end-to-end anastomosis were performed.
case_images: 10-1055-a-2280-9708-i2023110737cr-1.jpg
case_images: PMC10965298_01_10-1055-a-2280-9708-i2023110737cr-1.jpg
case_images: FI2023110737cr-1
case_images: However, the left testis was positioned higher in the inguinal canal ( Fig. 1 ). The laparoscopy was done the next day, and it revealed remarkably dilated intestines, serous ascites, and an ischemic intestine in the left groin ( Fig. 1 ). During the operation, the patient was head down positioned and we tried to retrieve the ischemic intestine by pulling this by grasp forceps from inside and pushing the bulge from outside but the ischemic intestine could not be retrieved ( Fig. 1 ). A lower midline laparotomy was performed, revealing reduction en masse of the left inguinal hernia with a strangulated ileum at its neck ( Fig. 1 ).