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Hernias containing organs like the cecum, appendix, sigmoid colon, ureter, and omentum are less common compared to typical inguinal hernias involving the small intestine. Patients typically present with inguinoscrotal swelling. A 53-year-old male with ischemic heart disease, diabetes, and hypertension presented with vomiting and no bowel movement for 24 h. He had a long-standing left inguinoscrotal hernia and recently underwent cardiac catheterization. Examination showed a massive hernia and an empty rectum. Imaging confirmed a small bowel obstruction. Surgery revealed an incarcerated hernia containing multiple organs, which were reduced, and hernioplasty was performed. Postoperatively, he developed abdominal compartment syndrome, necessitating decompressive laparotomy. His abdomen was closed on day 13, and he was discharged on day 30. Hernias, particularly when they become incarcerated, pose significant risks to patients. If untreated, they can progress to strangulated hernias, leading to bowel ischemia and potentially fatal outcomes. Inguinal hernias are diagnosed primarily through clinical examination. It is rare for these hernias to contain the cecum, appendix, sigmoid colon, ureter, and omentum, and such cases are typically associated with intestinal obstruction. • Uncommon inguinal hernias may contain organs such as the cecum, appendix, sigmoid colon, ureter, or omentum, which differ from the more typical involvement of the small intestine. • These hernias often present with noticeable inguinoscrotal swelling due to the presence of larger organs within the hernia sac. • Despite their rarity, hernias containing these organs can lead to significant symptoms and complications if left untreated, necessitating timely surgical intervention. [ABSTRACT FROM AUTHOR]