The most common etiology of bile duct obstruction in patients with cholelithiasis is choledocholithiasis. The diagnosis of cholelithiasis is based on clinical suspicion and confirmed by ultrasound (US) of the liver and bile ducts. The management of bile duct lithiasis has evolved considerably and currently, ERCP is the most common and recommended technique. However, in cases of multiple lithiases, fragmentation of the lithiasis during extraction, excessive preoperative or transoperative handling of the ampullary region, previous stenosis of the ampullary region, juxtapapillary diverticula, primary bile duct stones, or residual intrahepatic stones, a large number of hospitals do not have sufficient resources to perform minimally invasive procedures and offer these therapeutic alternatives instead.

Primary testicular lymphoma is a rare disease that has a higher incidence in patients over 60 years of age, presenting as an increase in volume in the inguinal region, which is usually painless and slow-growing. In the case that we present, it is a patient who was initially diagnosed with an indirect inguinal hernia due to the findings on examination and ultrasound, without presenting relevant findings in the laboratory studies, during the trans-operative we found testicular tumor compatible with diffuse large B-cell lymphoma, this being the most common variant of testicular lymphoma. This case emphasizes on importance of pre-operative suspicion in older age patients with increased volume in the groin region and without a clear diagnosis.

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