Direct inguinal hernias are less likely to present as incarceration or strangulation as compared to indirect inguinal hernia, because they have wide neck. We present a case of an 80-year-old male presented with irreducible and painful swelling over the right inguinal region and features of intestinal obstruction. On exploration the obstructed hernia was found to be a direct type with gangrenous sac wall containing congested extra peritoneal pad of fat, cord structures, even the right testes was gangrenous. After gaining viability the content was reduced, posterior wall defect was closed and modified Bassini's repair was done with a right orchidectomy. A long standing direct inguinal hernia may present as acute or sub acute intestinal obstruction especially in elderly patients. Therefore, we should repair direct inguinal hernias on an elective basis in any age group.
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