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Testicular torsion is a urologic emergency that needs immediate attention and treatment. However, the occurrence of torsion of the undescended testis (UDT) is uncommon which make the dilemma of diagnosis of the torsion in undescended testis is challenging. We are reporting a case of a Malay teenager presented with one day history of inguinal swelling and pain. On examination the swelling measured3 cm x 5cm at inguinal region with erythematous skin changes. However, no testes felt at left hemiscrotum. Provision diagnosis of strangulated right inguinal hernia with differential diagnosis of inguinal abscess or torsion of left undescended testicle was made. We proceeded with left inguinal exploration. We performed orchiectomy in view of non-viable left testes. This case discusses the diagnostic dilemma and the treatment options in a left inguinal swelling mimicking a strangulated inguinal hernia presentation.
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