Acute scrotum is a common surgical emergency and has a vast array of differential diagnoses; ranging from the very common conditions like epididymo-orchitis and testicular torsion to the rare conditions like haematocele, infected hydrocoele, pyocoele, necrotic testicular malignancy and incarcerated or obstructed inguinal hernia. Painful scrotal swelling secondary to spontaneous thrombosis of Pampiniform Venous Plexus (PVP) is extremely rare, and so far, only 30 cases have been reported worldwide. We hereby report a case of painful inguio-scrotal swelling, diagnosed as incarcerated inguinal hernia on clinical and radiological evaluation, but turned out to be thrombosed Pampiniform Plexus (PP) on surgical exploration. This is probably the first case of spontaneous PVP thrombosis reported from Indian sub-continent.