The patient had had bilateral inguinal hernia repair many years previously.

Physical examination elicited tenderness in the right lower abdomen and the right groin. Huge rigid right scrotum. Impression of an inguinoscrotal hernia, signs of incarceration.
WBC 20K/uL with neutrophilia.
Abdominal x rays showed dilated small bowel loops with air-fluid levels.
CT abdomen showed that the etiology for small bowel obstruction was indeed the left inguinoscrotal hernia.

The hernia contents were explored: it contained a ~20 cm segment of small bowel with signs of strangulation but also a loop of the sigmoid colon. Due to an old mesh, the floor of the inguinal canal could not be restored, so a Prolene (polypropylene) mesh was laid down and fixed to the pubis, the conjoint tendon, and the ligament of Poupart while conserving the spermatic cord.