PMC6082973_01
A closed loop of small bowel (thin yellow arrow) with beaking of the bladder (thick red arrow).
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PMC6082973_01_gr1.jpg
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Abdominal computed tomography (CT) scan showed a closed loop of small bowel around the right inguinal region and the beaked bladder compressed by a mass of small bowel (Fig. 1).
a) Treatment of the incarcerated bowel. b) Fibrosed neck of the loosened hernia sac (thin yellow arrow).
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The incarcerated bowel was observed in the right inguinal region and was gently dragged out of the hernia sac, of which the fibrosed neck caused the strangulation (Fig. 2).
a) The plug may migrate into the preperitoneal space (thin yellow arrow) and may not close the hernial orifice (thick red arrow). b) Complete resolution of the hernial orifice after ligation of the hernial sac and insertion of the Modified Kugel  Patch into the preperitoneal space.
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PMC6082973_01_gr3.jpg
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Laparoscopic observation showed that the hernial orifice had been correctly repaired, and the patch was placed in the preperitoneal space without migration (Fig. 3b).