Abstract Aim Management of a strangulated parastomal hernia (PH) around the ileal conduit can be a surgical challenge. We demonstrate here a safe and effective laparoscopic repair of a strangulated PH in the emergency setting for a 53year-old morbidly obese woman (BMI: 40). Method Entry to abdominal-cavity was by Veress-needle technique. PH defect was identified – containing strangulated part of ascending-colon that reduced spontaneously during creation of pneumoperitoneum. Adhesiolysis around stomal defect up to lateral attachment of ileal conduit was completed. 3cm defect was opposed using transfascial nonabsorbable sutures. 15cm circular-composite-mesh was fashioned U-shaped and introduced in medial to lateral direction with the U lips overlapped and fixed snug laterally around the ideal conduit. Mesh was further fixed through double-crown fixation. Results Patient had an uneventful recovery and discharged on the second post-operative day. A 10-month CT as a part of bladder cancer follow up showed no PH recurrence. Conclusions This case shows that strangulated PH around an ileal conduit, an uncommon presentation, can be successfully managed laparoscopically even in the emergency setting especially for patients of high BMI with proper assessment and appropriate expertise. Successful management of this challenging presentation of strangulated PH around ileal conduit demonstrates the safe and effective use of laparoscopic surgery especially in the emergency setting for patients of high BMI.