Strangulated inguinal hernia with testicular gangrene and bowel ischemia.

Strangulated inguinal hernia is a common surgical emergency; however, associated testicular gangrene with concomitant bowel ischemia in adults is exceptionally rare. We report the case of a 69-year-old male who presented with systemic instability and an incarcerated right inguinal hernia. Clinical deterioration necessitated urgent exploratory laparotomy, which revealed a strangulated segment of small bowel extending into the inguinal canal. Bowel resection with primary anastomosis was performed. Further exploration demonstrated complete gangrene of the spermatic cord and testis, requiring right orchiectomy. The patient developed postoperative pulmonary embolism and partial small bowel obstruction, which were managed successfully with multidisciplinary care. He was discharged in stable condition. This case highlights the importance of early recognition and prompt surgical intervention in complicated inguinal hernias to prevent catastrophic vascular compromise of bowel and testicular structures.