Inguinal dermoid cyst in Hesselbach's triangle with diagnostic and surgical decision-making challenges: a case report

Inguinal dermoid cysts are exceedingly rare, with most reported cases arising from the spermatic cord in male patients or the round ligament in female patients. We report a rare case of a inguinal dermoid cyst in a young woman presenting as an irreducible inguinal mass with gradually increasing local discomfort. Preoperative imaging suggested a benign but nonspecific cystic lesion, extending from the preperitoneal plane to the layer beneath the external oblique aponeurosis. The lesion was excised using a combined laparoscopic and open approach. Intraoperative cyst rupture released sebaceous material and hair, prompting reconstruction using a McVay tissue repair. Combined intraoperative and histopathological findings supported the diagnosis of dermoid cyst. This case highlights the need for a broad differential diagnosis of atypical irreducible inguinal masses and carefully integrating clinical, imaging, and intraoperative findings to facilitate accurate diagnosis and guide appropriate surgical management.