In clinical practice the spermatic cord abscess is uncommon and is not enough studied or understood by a wide range of radiologists, surgeons and urologists diseases. The article presents a rare case of abscess scrotal part of the spermatic cord, complicated external scrotal fistula, acute purulent deferentitis and epididymitis, 70-year-old patient who is 2.5 months ago underwent enucleation of cyst of the head of the epididymis. General and local clinical laboratory inflammatory symptoms of abscess of the spermatic cord and its associated purulent forms of deferentitis and epididymitis were not clinically expressed, had erased the character that is obviously explained by the reduced reactivity of the patient's body on the background of immunodeficiency caused by obesity and diabetes. Cause abscess formation, spermatic cord in our case is not entirely clear. The occurrence of abscess of the spermatic cord, probably due to previous surgery to remove a large cyst of the head of the epididymis. The use of high-resolution ultrasound examination of the spermatic cord and scrotum organs, supplemented by dopplerangiography allowed to specify the diagnosis and to determine the treatment strategy. As the optimal method of treatment was orchifuniculectomy that is probably justified in this situation, given the complications of abscess of the spermatic cord (in the form of external scrotal fistula, acute purulent funiculitis, acute purulent deferentitis and acute purulent epididymitis), and advanced age of the patient. Possible ways of etiopathogenesis, clinical picture, diagnosis and treatment of abscess of the spermatic cord, presented in the literature, are discussed.