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A hernia containing a Meckel’s diverticulum is termed a Littre hernia, with the mixed subtype describing the presence of additional abdominal viscera. Mixed Littre hernias are rare and often identified intra-operatively. We report the case of a man in his 60s undergoing a right inguinoscrotal hernia repair who was found to have a 10 cm Meckel’s diverticulum with a loop of ileum within the hernia sac. The diverticulum appeared normal and was managed non-operatively with no complications at 6 months. Management of an incidental Meckel’s diverticulum remains controversial, divided between non-operative and operative management which can include selective or routine prophylactic resection. High-quality evidence is limited, and existing studies focus on intra-abdominal Meckel’s diverticula rather than those within a hernia sac which may have a distinct risk profile. Further research and development of guidelines are required to guide intra-operative decision making in rare cases such as a mixed Littre hernia.