Urgent management of a giant scrotal hernia. An unusual case of giant scrotal hernia is presented. Hernias of this magnitude are extremely rare, even in underdeveloped countries, and their repair is challenging to the surgeon and stressful to the patient. Only a few case reports on the use of pneumoperitoneum prior to herniorrhaphy have been published; however, our patient's accompanying complications of diabetes mellitus and gastrointestinal symptoms precluded the use of pneumoperitoneum. The emergency management, including the expansion of the abdominal cavity with prosthesis, the ensuing postoperative complications, and the patient outcome, are discussed. 