 Good morning. Myself Dr. Harshita Shakti, I am a second year radiology resident from KM Hospital, Mumbai and I'll be presenting a case series of acute testicular ischemia caused by incarcerated inguinal hernia. Patients presenting with acute scrotal pain to the emergency department should be evaluated for potentially reversible causes of testicular ischemia. The causes of acute scrotal pain include testicular torsion, apididymitis, ponious gangrene and scrotal trauma. Testicular ischemia can also be caused by large incarcerated inguinal hernias due to compression of the testicular vasculature. It is more commonly seen in infants and children due to the delicate vasculature and lack of collateral. However, rarely it can be seen in adults too. Following is a case series of three patients presenting to the emergency department with incarcerated inguinal hernias with significantly reduced ipsilateral testicular vascularity which was promptly restored to normal after reduction of the hernia. The first case, a 30-year-old man came to the emergency department with acute onset left-sided scrotal pain. He was referred for an emergency ultrasound examination. Ultrasound shows a loop of the jejunum with misery herniating through the deep inguinal ring reaching up to the upper pole of the left testis. The vascularity of the herniated bobble loops was well maintained. The vascularity of the left testis was significantly reduced. However, no twisting of the spomatic cord was seen. Ultrasound shows a herniated loop of the jejunum in the inguinal canal reaching up to the upper pole of the testis with maintained vascularity of the wall. The transition point is seen at the neck of the sac. The vascularity of the left testis was significantly reduced as compared to the right one, suggestive of testicular ischemia secondary to compression of the spomatic cord by the herniated bobble loops and misery. The on-call surgical resident was consulted for reduction of the hernia. Post-manual reduction, the patient experienced immediate relief of his scrotal pain. A repeat ultrasound examination was performed to look for the vascularity of the testis and the vascularity was found to be normal. Second case, a 45-year-old man had presented to the emergency with a large right inguinal swelling since two years. On examination, there was a large indirect right inguinal hernia. An ultrasound was suggested while transferred to the ultrasonography room, the patient developed excruciating right testicular pain. The right testis shows significantly reduced vascularity with herniated bobble loops in the right scrotum. Scrotal ultrasound Doppler images showed decreased vascular flow in the right testicle as compared to the left and a large herniated sac with its content within the right scrotal sac. The scrotal sonogram showed compromised vascular flow to the right testicle. Surgery on-call resident was consulted. Hernia was reduced after 10 minutes of manual pressure. Immediate relief of symptoms were noted post-reduction. After reduction of the hernia, scrotal ultrasound was repeated which shows re-established vascular flow to the right testicle. Case three, a 28-year-old man had come with acute onset left scrotal and abdominal pain with multiple episodes of vomiting and obstipation. An ultrasound examination revealed a loop of the bobble ball herniating through the deep inguinal ring. The bobble ball did not show any vascularity within. A diagnosis of strangulated inguinal hernia was made. Incidentally, the left testis had minimal vascularity. However, there was no twisting of the schematic cord. The bobble loop herniating through the deep inguinal ring does not show any vascularity in its walls suggestive of strangulation. Doppler examination shows minimal vascularity in the left testis. The patient underwent a resection and anastomosis surgery for the strangulated inguinal hernia. A repeated ultrasound examination was performed on post-op day one which shows restoration of the testicular vascularity. Inguinal hernia is very common in adults. However, an indirect inguinal hernia causing testicular ischemia or infarction is a very rare presentation. Severe testicular ischemia can be caused due to incarcerated inguinal hernias causing acute testicular pain which is promptly relieved on reduction of the hernia. Testicular salvage ability depends on the duration of ischemia with only 20% been salvageable after 12 hours. There are three case reports with the patient having to undergo an orchidctomy due to testicular infarction caused by inguinal hernias, especially those containing momentum within. Most reports of testicular ischemia with incarcerated inguinal hernias state that testicular ischemia was not anticipated but found incidentally during surgical repair. Therefore, practitioners should consider doing a scrotal Doppler examination in previously diagnosed inguinal hernias presenting with incarceration of the hernia to look for the presence of testicular ischemia and expedited reduction of the hernia to restore testicular vascularity and fertility. These are my references. Thank you.