Inguinal ureteral and concomitant urinary bladder hernia is an exceptionally rare phenomenon. It is reported that diagnosis of urinary bladder involvement in inguinal hernias are extremely difficult to make with about only 7% of such cases being identified preoperatively. We present a case of a 70-year old man with such inguinal hernia presenting with acute scrotal hemorrhage. Our patient presented with signs of sepsis (due to urinary tract infection) and no symptoms of strangulation. Due to the high risk of developing respiratory failure during the post-operative period of a giant hernia such as the one our patient presented with, a conservative approach with creation of nephrostomy was utilized. The patient currently is being followed up and awaiting complete surgical repair.