Aim: Giant inguinal hernia is a rare presentation; it is challenging issue for both physician and surgeons, 
especially if it is strangulated and neglected. In such circumstances it needs a special management and 
judicious surgical interference with major gut resection, in addition to orchidectomy to perform obliteration 
repair of inguinal canal in such infected field. 
Case presentation: An old blind male 60 years age presented to the casualty department Assuit university 
hospitals complaining of two weeks history of intestinal obstruction symptoms on top of a longstanding giant 
inguinal hernia that was progressing since 20 years. Examination revealed neglected strangulation of lt. 
inguinal hernia in a high risk patient, with patches of scrotal skin gangrene. Urgent preparation and control 
of the risk factors was done, followed by surgical interference through inguino-scrotal and abdominal 
incisions for resection anastomosis of the strangulated intestine, Lt. Orchidectomy, and obliteration repair of 
the Lt. inguinal canal. Gangrenous infected scrotal skin was resected prior delayed primary closure. 
Conclusion: In spite of the advancement of medical care and hospitals, still neglected cases may be seen in 
surprisingly huge sizes, usually complicated, that needs a special care and wise decision especially if 
associated with other risks. Unilateral orchidectomy still may be a solution in such old feeble patient, with 
infected surgical field, with obliteration repair of inguinal canal.