Giant inguinoscrotal hernia with loss of domain complicated by scrotal abscess requiring bowel resection, orchiectomy, and component separation.

Giant inguinoscrotal hernias (GIH) are rare and are often complicated by loss of domain (LOD), incarceration, and chronic soft tissue changes. We report a 51-year-old male with a 30-year history of a progressively enlarging left inguinoscrotal hernia extending to the knee, who presented with abdominal pain and leukocytosis. Computed tomography demonstrated marked LOD without strangulation. Intraoperatively, a large scrotal abscess with soft tissue necrosis was identified in the setting of chronic dense bowel adhesions and spermatic cord involvement. Management required combined abdominal and inguinoscrotal approaches, small bowel resection with anastomosis, orchiectomy, and bilateral anterior component separation with absorbable biosynthetic mesh reinforcement. Due to concern for abdominal compartment syndrome following closure, the patient required planned postoperative intubation and paralysis. He was discharged on postoperative day 9 without major complications. This case highlights the complexity of GIH repair and underscores the importance of individualized operative planning and multidisciplinary perioperative management.