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Inguinal hernia repair is one of the most common surgeries performed in the department of general surgery throughout the world. However, the presence of a vermiform appendix in the hernial sac, also known as Amyand's hernia, along with a perforated cecum is very rare. We report the case of an elderly male presenting to the surgery emergency with a strangulated, large, right-sided inguinal hernia containing perforated cecum and vermiform appendix as contents in the sac. Resection of the ileocecal segment and side-to-side ileocolic anastomosis of the bowel was performed. Anatomical repair of the hernia was done without the use of mesh.