The complication of testicular infarction after incarcerated inguinal hernia is uncommon. It is so uncommon that the reasons for accepted surgical management of these testes, heretofore, seem unclear or poorly emphasized.
Simple venous obstruction by hernia pressure anywhere from the internal inguinal ring outward starts the chain of events. Swelling of the cord and testes, venous thromboses, and hemorrhage ensue. Final arterial insufficiency from the swelling and enclosed space pressure of the tunica albuginea completes "congestive infarction." The delicate vasculature, plus the high rate of hernia incarceration, in infants must explain the almost total confinement of incidence of this condition in this age group.3,4,9,12,14,15
Current pediatric surgery texts advise conservative management of incarcerated hernias for 4-5 hours, but this seems illogical. There is no evidence of a safe period of incarceration regarding testicular circulation, much less incarcerated intra-abdominal viscera. The physical signs reliably predicting testicular gangrene are lacking. Even