IBIMA Publishing International Journal of Case Reports in Medicine http://www.ibimapublishing.com/journals/IJCRM/ijcrm.html Vol. 2013 (2013), Article ID 692094, 5 pages DOI: 10.5171/2013.692094 _____________ Cite this Article as: Imtiaz Wani, Mubashir Shah, Ajaz A. Malik and Sameer H. Naqash (2013), “Giant Inguinal Hernia: A Case Report,” International Journal of Case Reports in Medicine, Vol. 2013 (2013), Article ID 692094, DOI: 10.5171/2013. 692094 Case Report Giant Inguinal Hernia: A Case Report Imtiaz Wani, Mubashir Shah, Ajaz A. Malik and Sameer H. Naqash Department of General Surgery, SKIMS, Srinagar, Kashmir, India Correspondence should be addressed to: Imtiaz Wani; imtazwani@gmail.com Received 10 March 2013; Accepted 4 April 2013; Published 24 September 2013 Academic Editor: Ahmet Ziya Anadol Copyright © 2013 Imtiaz Wani, Mubashir Shah, Ajaz A. Malik and Sameer H. Naqash. Distributed under Creative Commons CC-BY 3.0 Abstract Giant inguinal hernia is rare. This may be asymptomatic or present with the complications. Contents vary from colon, small gut, vermiform appendix, mesentery, to omentum. A case of giant inguinal hernia in a 62-year-old male who presented with features of intestinal obstruction is reported. Patient had giant inguinoscrotal hernia which was tender, irreducible, and had no cough impulse. Emergency exploration via inguinoscrotal approach revealed that contents were small and large intestines, omentum, mesentery, and vermiform appendix. Right orchidectomy, reduction of contents into abdominal cavity after enlarging internal ring with a double layer closure of wall, and the reconstruction of scrotal skin were done. Giant inguinal hernia presenting as intestinal obstruction is rare. Keywords: Giant; Inguinal; Hernia; Enlarging; Internal ring. Introduction Giant inguinal hernias are seen much less these days. In the West, they are almost not seen now. When inguinal hernia extends below the midpoint of inner thigh in standing position, it is a giant inguinal hernia (Sarkarbi et al. 2005). In a developing country, unseeking of medical advice and reluctance to get examined lead to gradual enlargement evolving into a giant hernia. These are always longstanding, present for years, and remain asymptomatic or present with an atypical presentations. Rarely, a giant hernia presents as an intestinal obstruction. Contents of giant inguinal hernia are gut, mesentery, or omentum. Surgical repair is often challenging and difficult because of loss of domain (King et al. 1986 and Veihelmann et al. 2001). Reduction of contents in giant inguinal hernia may lead to cardiopulmonary arrest due to elevation of intra-abdominal pressure and elevation of diaphragm. Elective repair employs usually creating of pneumoperitoneum before repair. Emergency repair of giant inguinoscrotal hernia remains always challenging and may lead to morbidity. Reduction of contents via enlarging internal ring in giant inguinal hernia is rarely reported (Coetzee et al. 2011). Case Report A 62-year-old male presented with abdominal pain, vomiting, and constipation of 2 days duration. He had recurrent attacks of lower