To evaluate the association of preoperative inflammatory markers and CT findings with bowel ischemic necrosis in adults with incarcerated inguinal hernia and to describe the selection of surgical procedure and short-term outcomes according to different timing of intervention.

This was a single-center retrospective cohort study. Clinical data of 57 adults patients with incarcerated inguinal hernia admitted to Chuxiong Yi Autonomous Prefecture People's Hospital between November 2022 and February 2025 were retrospectively analyzed. Patients were divided as emergency surgery group (n=34) or scheduled surgery group (n=23) according to the initial intervention. The scheduled group comprised 15 patients after successful manual reduction and 8 after short observation; all underwent surgery during the same admission, with an observed interval of 1-4 days. Inflammatory markers (white blood cell count, C-reactive protein, neutrophil-to-lymphocyte ratio), CT findings, operative approach, bowel resection, mesh repair, and complications of the two groups were recorded.

The scheduled group was younger than the emergency group [(58.1±16.9) versus (67.1±13.2) years, t=2.254, P=0.028] and had a lower proportion of elevated inflammatory markers [4.3% (1/23) versus 58.8% (20/34), P<0.001]. All seven patients with irreversible bowel ischemic necrosis had elevated inflammatory markers and at least one CT sign related to ischemia; all underwent bowel resection in the emergency group. No clinically diagnosed case of delayed bowel necrosis was documented in the scheduled group based on medical records, operative findings, and follow-up. Laparoscopic procedures were performed more frequently in the scheduled group. A total of five patients in the two groups developed postoperative complications, all of which resolved after conservative management.

In this cohort, every case of bowel necrosis was accompanied by elevated inflammatory markers and CT findings related to ischemia. Scheduled surgery during the same admission after manual reduction may be feasible in carefully selected low-risk patients; the observed 1-4 days interval should not be interpreted as a validated optimal time window.