Acute scrotal pain is a clinical entity encountered in surgical emergency departments. The most common differential diagnosis encountered during the evaluation in these patients is acute epididymoorchitis, acute torsion testis, or a strangulated hernia. However, finding a tumour during surgical management is sometimes a surprise for the surgeon and also to the patient. This report intends to help us better understand this clinical entity and spread awareness among surgical faculty to keep this diagnosis in the back of mind. This is a case report of leiomyoadenomatoid tumour also known as adenomatoid leiomyoma with an acute presentation.