Hernia and abdominal wall: reduction en masse: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Hernia and abdominal wall: reduction en masse

Sample item

A 70-year-old man with a painful irreducible inguinal hernia is treated by forceful manipulation elsewhere and the lump disappears. Severe pain, vomiting and obstruction persist with no swelling to be felt in the groin. What has occurred?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Reduction en masse

In reduction en masse, the sac with its constricting neck is pushed back into the abdominal wall or preperitoneal space, so the lump vanishes but the strangulation continues. It needs urgent laparotomy. Forceful taxis of a tender irreducible hernia is therefore discouraged.

Option by option

  • A. Pantaloon hernia

    A pantaloon hernia has sacs on both sides of the inferior epigastric vessels and is not a result of manipulation.

  • B. Richter hernia

    Richter hernia traps part of the bowel wall and a lump is still present.

  • C. Maydl hernia

    Maydl hernia has two loops in the sac and the connecting loop in the abdomen, and the lump remains.

  • D. Reduction en masse (correct)

    Correct. The sac and its tight neck are pushed back together, so the strangulated bowel remains trapped without a visible lump.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Reduction en masse. In reduction en masse, the sac with its constricting neck is pushed back into the abdominal wall or preperitoneal space, so the lump vanishes but the strangulation continues.

Why is "Pantaloon hernia" not the answer?

A pantaloon hernia has sacs on both sides of the inferior epigastric vessels and is not a result of manipulation.

Why is "Richter hernia" not the answer?

Richter hernia traps part of the bowel wall and a lump is still present.

Why is "Maydl hernia" not the answer?

Maydl hernia has two loops in the sac and the connecting loop in the abdomen, and the lump remains.

What concept does this question test?

It tests Hernia and abdominal wall: reduction en masse in General Surgery. It needs urgent laparotomy. Forceful taxis of a tender irreducible hernia is therefore discouraged.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hernia and abdominal wall: reduction en masse?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.