Pediatric spermatic cord fibrolipoma presenting as acute scrotum: a rare case report and literature review.

Fibrolipoma of the spermatic cord is an exceptionally rare benign tumor in the pediatric population that seldom presents as acute scrotum. Only one pediatric case has been reported. We present the second known case, highlighting diagnostic and therapeutic challenges. A 12-year-old boy presented with a 10-day history of right inguinal pain and swelling. Examination revealed a tender inguinal mass with normally positioned painless testes. Ultrasound demonstrated a hyperechoic lesion within the inguinal canal suspected to be an incarcerated omental hernia. Laparoscopy showed obliterated inguinal rings; subsequent open exploration revealed a well-circumscribed fibroadipose mass arising from the spermatic cord. Cord-sparing excision was performed, and histopathology confirmed the diagnosis of fibrolipoma. Outcome was favorable. Fibrolipoma of the spermatic cord should be considered in the differential diagnosis of acute inguinal masses. Laparoscopy can play a pivotal role both for diagnostic clarity and therapeutic benefit. A literature review is performed to contextualize our case.