Testicular pain following...

A 41 years-old male presented to the emergency department with severe right testicular pain, and fever for 48 hours. He had a previous left orchidectomy for left epididymo-orchitis from a sexually-transmitted disease. The patient was not immunosuppressed and did not take any regular medications. On examination, the patient was tachycardic, hypotensive, and febrile to 39˚C. A focused examination of the patient's scrotum revealed a single right testicle, grossly swollen, significantly tender and markedly indurated. On investigation, the patient had acutely elevated white cell count of 23 109 /L, C-reactive protein of 120 mg/L and an elevation of his creatinine level at 150 mol/L, indicating acute kidney injury. In the emergency department, the patient was resuscitated with intravenous fluid and supplemental oxygen. He subsequently had an ultrasound revealing sluggish arterial flow with absence of end-diastolic blood flow. A graft was harvested from tunica vaginalis and patched over the defect with interrupted absorbable sutures. Post-operative ultrasound on day one confirmed restoration of end diastolic blood flow and the presence of arterial blood flow. The patient was discharged after receiving further 48 hours of intravenous antibiotics.