Background: Scrotal swellings are a common problem occurring in almost all age groups encountered in day-to-day surgical practice. Most of the patients present late and are reluctant to seek medical attention due to the social stigma and embarrassment associated with the disease. The aim of this study is to identify the age distribution of the disease in adults, its etiology, modes of presentation, modalities of treatment, and the post-operative complications. This is a prospective hospital-based study conducted in the Department of Surgery, Jorhat Medical College and Hospital, Assam, India. A total of 40 cases with scrotal swelling and fulfilling the study criteria were selected for the study. Detailed history and clinical examination along with ultrasonography of bilateral scrotum with color doppler was done in all the cases. Treatment options were selected based on the disease condition and were either surgical or conservative. Intra-operative findings were noted and post-operative complications were recorded. The data collected was then analyzed using tables and figures. Most of the patients were in the age group of (29-38) years. Majority of the patients presented with painless scrotal swelling. Primary vaginal hydrocele was the most common cause of scrotal swelling, followed by epididymo-orchitis and they were common in the age group of (29-38) years. 62% of the patients were treated surgically, whereas the rest underwent conservative management. Pain was the most common post-operative complaint.