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Author(s): Sai Prasuna Vudata (corresponding author) [1]; Anusiri Inugala [1]; Sai Krishna Vuppala [1]; Revanth Kumar Banda [1] INTRODUCTION Transverse testicular ectopia (TTE) is a rare anomaly in which both [...], Introduction: Transverse testicular ectopia (TTE) is an uncommon urological abnormality in children where both the gonads migrate toward the same hemi-scrotum. Herein, we describe five cases of children with TTE and their management at a tertiary care center. Materials and Methods: Five cases with complaints of inguinal hernia and undescended testis were presented to the department of pediatric Surgery at a tertiary care center have been taken up for the study. The history, investigations, surgical findings, and procedures were reviewed retrospectively. Case Summary: Of the five cases, one presented with irreducible inguinal hernia, two presented with unilateral hernia with contralateral undescended testis, and two presented with bilateral undescended testes. Inguinal herniotomy and transseptal orchiopexy were performed in all 5 cases. Three of the five cases were associated with persistent Müllerian duct syndrome (PMDS). Conclusion: In children with unilateral cryptorchidism and a contralateral descendent testis with an associated hernia, TTE should be suspected and ultrasonographic evaluation must be done to diagnose this condition before surgery. Transseptal orchiopexy is highly recommended to manage these cases especially when vasa deferentia are fused. In the case of PMDS, it is preferred to preserve Müllerian remnants. Keywords: Inguinal hernia, persistent Mullerian duct syndrome, transseptal orchiopexy, transverse testicular ectopia, undescended testis, Key message:, 1. For cases with unilateral cryptorchidism and a contralateral descendent testis with an associated hernia, should raise a suspicion of TTE., 2. Ultrasonographic evaluation is to be done to diagnose this condition before surgery., 3. Intraoperatively, TTE may be associated with persistent Mullerian structures, hence the need for cautious separation of these structures from Vas deferens.