Inguinal hernias may also present acutely and, if incarcerated, do represent a true surgical emergency. If manual reduction is unsuccessful, ischemic necrosis of the contents of the hernia is a significant concern, and therefore, emergent hernia repair is necessary. Examination will demonstrate an inguinoscrotal mass with a thickened spermatic cord (Fig. 8.46). Occasionally the underlying blood supply to the testis may become compromised and US will not be able to distinguish if concomitant torsion is present with the hernia. Exploration will reveal compression of the spermatic vessels by the hernia and its contents.
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