Ruptured abdominal aortic aneurysm is a great masquerader that can present in a variety of clinical symptoms and signs. This is a case of ruptured abdominal aortic aneurysm that presented as a strangulated left inguinal hernia. The diagnosis of an inguinal hernia, be it complicated or uncomplicated is often simple and straight forward. Rarely this simple presentation may be the external manifestation of a distant pathology, which is in communication with the inguinal canal through its anatomic relationship. . Familiarity with the surgical emergencies that can mimic or present as simple irreducible hernia would enable a rapid diagnosis to be made with timely subsequent intervention. During exploration the presence of haematoma with in the cord warrants further laparotomy. Contrast enhanced CT scan is recommended for all dubious cases at an early stage.
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