A case report of femorocele mimicking a spermatic hydrocele in a male patient: the first laparoscopic repair.

Introduction: Femorocele, defined as fluid accumulation within a femoral hernia sac, is an extremely rare condition; to our knowledge, previously reported cases have predominantly occurred in female patients, and laparoscopic management has rarely been described. Case presentation: A 75-year-old man presented with a gradually enlarging, painless swelling in the left groin. Computed tomography revealed a cystic lesion that was initially diagnosed as a spermatic hydrocele. In response to rapid enlargement and onset of pain, elective laparoscopic transabdominal preperitoneal (TAPP) repair was performed. Intraoperatively, the hernial orifice corresponded to the femoral ring, and the neck of the hernial sac was constricted by thickened preperitoneal fat with minimal communication with the peritoneal cavity. The sac contained only clear fluid without bowel or omentum, leading to a diagnosis of a primary femorocele. Mesh repair was successfully completed; the postoperative course was uneventful. Discussion: Given their rarity and nonspecific imaging findings, femoroceles are frequently misdiagnosed preoperatively. To our knowledge, this appears to be the first reported case of a femorocele being treated laparoscopically. Laparoscopic TAPP repair provides excellent visualization of the femoral ring and surrounding anatomical structures, thereby enabling both accurate intraoperative diagnosis and definitive treatment. Compared with open or robotic approaches, laparoscopic repair is widely available, cost-effective, and particularly suitable for use in community hospital settings. Conclusion: Femoroceles can occur in male patients and should be considered in the differential diagnosis of cystic groin masses. Laparoscopic TAPP repair demonstrates the feasibility that offers combined diagnostic and therapeutic advantages for this rare condition.