Reversible testicular ischemia with reduction of previously incarcerated inguinal hernia in an infant demonstrated with ultrasound.

Inguinal hernias are common in infancy, with a high risk of incarceration in those under six months of age. While clinical focus typically resides on bowel compromise, incarceration can lead to testicular ischemia due to compression of the spermatic cord within the hernia sac. This case report illustrates reversible testicular ischemia due to an incarcerated inguinal hernia, identified on ultrasonography and confirmed by return of perfusion after hernia reduction. A 45-day-old male infant presented to the pediatric emergency department with acute irritability and a tense, tender right inguinoscrotal mass. A previous ultrasound had shown a reducible hernia. However, during this presentation the baby remained irritable despite reduction of the incarcerated hernia. Emergent Doppler ultrasonography revealed a large right inguinal hernia with absent vascular flow to the right testis, though the bowel appeared viable. Following the administration of analgesia, gentle manual reduction was performed. Immediate post-reduction Doppler imaging confirmed the restoration of arterial and venous flow, indicating transient ischemia. The patient subsequently underwent successful laparoscopic bilateral inguinal hernia repair. ?Emergency physicians must recognize that testicular ischemia is a critical, yet potentially reversible, complication of incarcerated hernias. Because testicular compromise can occur independently of bowel ischemia, a viable-appearing bowel on imaging does not rule out the need for urgent intervention. Early identification via Doppler ultrasonography and prompt manual reduction are essential to restoring perfusion and preventing permanent testicular loss.