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Acute epididymitis and orchitis result in pain and swelling of the contents of the scrotal sac. The differential diagnoses include torsion of the spermatic cord, torsion of the appendix testis, hernia, hydrocele, and trauma. All providers of pediatric health care should understand the etiology and recognize the presenting signs and symptoms of epididymitis and orchitis, conditions that must be distinguished promptly in the emergency setting to avoid the risk of gonadal loss or unnecessary scrotal exploration. Epididymitis results from inflammation of the epididymis with resultant pain, swelling, and redness of the scrotal skin. Most often a specific cause cannot be identified, although it has been hypothesized that both viral and coliform bacterial infections can inflame the epididymis.