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We report a 50-year-old man was brought to our Emergency Department due to fever and dyspnea for 2 days. The patient had difficulty in walking and was bed-ridden in the past 5 days due to massive right inguinoscrotal hernia. He had difficulty in micturition in the past 2 days. He was febrile with a body temperature of 39.5°C, a blood pressure of 82/50 mmHg, a pulse rate of 122 beats/minute, and a respiratory rate of 22 breaths/min. Physical examination showed left-sided costovertebral angle knocking tenderness and a large right-sided irreducible inguinoscrotal hernia. Initial laboratory examination revealed abnormalities as follows : l0 eukocyte counts 28.8 × 10 [3] /μL; procalcitonin >200 ng/mL; blood urea nitrogen 77.7 mg/dL; and creatinine 10.6 mg/dL. Computed tomography (CT) of abdomen displayed a large right inguinal hernia containing small and large intestine with compression on junction of bulbous and pendulous urethra. Coronal view of CT reviewed swelling and fat stranding of left kidney which indicated acute pyelonephritis.