Abstract
Scrotal hernias are common in the general population. Patients often present acutely reporting pain or sometimes with more severe symptoms if the hernia is strangulated or incarcerated. An 81-year-old man presented with left-sided iliac fossa pain with no other associated symptoms. On clinical exam, a left-sided non-reducible inguinoscrotal hernia was detected with no evidence to suggest strangulation. Imaging revealed a probable colorectal cancer with likely liver metastases. The patient went on to have open surgery to excise the tumour with clear oncological margins. Colorectal cancers contained within scrotal hernias are very rare occurrences. In this case, the surgeon had the advantage of preoperative images that identified the cancer. In some cases, this cohort of patients do not have such scans prior to surgery and the surgical team can be faced with a much more complex operation than anticipated.