INTRODUCTION: Transverse testicular ectopia (TTE) is a rare urogenital anomaly in which both testes descend through a single inguinal canal and enter the same hemiscrotum. While this condition is commonly diagnosed in childhood, often in conjunction with cryptorchidism, adult cases are infrequently reported, which contributes valuable insight for refining surgical management strategies. CASE PRESENTATION: A 40-year-old male from Ethiopia presented with a gradual onset of significant scrotal swelling accompanied by mild discomfort. Physical examination and scrotal ultrasound confirmed the presence of a hydrocele. During hydrocelectomy, both testes were found within the right hemiscrotum, having descended through a single inguinal canal, each with a separate spermatic cord. The patient underwent hydrocelectomy followed by trans-septal orchidopexy. He experienced an uneventful postoperative recovery and remained asymptomatic during follow-up. DISCUSSION: TTE is an uncommon condition, typically diagnosed in childhood, with rare instances in adulthood. It is often associated with cryptorchidism, hydroceles, inguinal hernias, and Müllerian duct remnants, and carries risks of testicular torsion, infertility, and malignancy. Surgical intervention is essential to prevent complications. CONCLUSION: Although TTE may occasionally be an incidental finding, it should be considered in adults presenting with cryptorchidism or other associated scrotal or inguinal abnormalities. Timely surgical correction, even in patients with prior offspring, is critical in reducing the risk of complications such as testicular torsion, malignancy, and to preserve future fertility.