INTRODUCTION: Littré hernia is defined as the presence of a Meckel’s diverticulum in any hernia sac. The case of an adult with Littré hernia associated with a cryptorchidic testicle in the inguinal canal has not been previously reported. Treatment of this rare case is controversial on many fronts. This report highlights the management of a case with an inguinal mixed Littré hernia and incidental cryptorchidism. CASE PRESENTATION: A 32-year-old male patient with an incarcerated right inguinal hernia presented to the emergency department. An incarcerated mixed Littré hernia was discovered associated with a cryptorchidic testicle. A Lichtenstein hernioplasty and an orchidopexy were performed without resection of Meckel’s diverticulum. DISCUSSION: There is currently no consensus on the treatment of a Littré hernia nor incidental cryptorchidism in an adult patient. Controversies arise on whether to perform diverticulectomy or not and the type of hernia repair. This case had the added unique feature of an undiagnosed cryptorchidic testicle in an adult, a pathology that also prolongs controversies on whether it is necessary to resect. CONCLUSION: Treatment of a Littré hernia, Meckel’s diverticulum, and cryptorchidism in adult patients continues to be a challenge. Given the lack of guidelines that establish appropriate treatment, it must be decided on a case by case basis; however, a conservative approach seems to be safe.