Small bowel perforation caused by direct blunt trauma to an inguinal hernia has rarely been reported. In this report, we present a patient with terminal ileum perforation after direct blunt trauma to an inguinal hernia region. Both perforation and hernia repair were managed surgically in the same stage. This case demonstrates that leaving an inguinal hernia unrepaired may lead to dangerous outcomes, such as intestinal strangulation and perforation. Inguinal hernias with intestinal perforation need urgent surgical intervention. It is possible to repair the intestinal perforation and inguinal hernia in the same operation.