Abstract
<title>Abstract</title> <p>Acute epididymo-orchitis after transurethral prostate surgery is uncommon and may mimic testicular torsion, particularly when severe inflammation compromises testicular perfusion. We report a case of Pseudomonas aeruginosa acute epididymo-orchitis after transurethral plasmakinetic prostatectomy that was initially managed as testicular torsion and later complicated by septic shock. The patient underwent surgery for bladder outlet obstruction in the presence of preoperative bacteriuria and inflammatory urinary findings. Early postoperative recovery was uneventful, but inflammatory markers remained abnormal at discharge and subsequently increased. On postoperative day 16, he developed acute scrotal pain, fever, leukocytosis, and markedly elevated C-reactive protein. Doppler ultrasonography showed epididymal enlargement and absent intratesticular blood flow, prompting emergency exploration for presumed torsion. Intraoperative findings were consistent with acute epididymo-orchitis with secondary pseudo-torsion and pyocele; the testis was viable and was preserved. Wound drainage cultures repeatedly yielded P. aeruginosa. Despite antimicrobial therapy and surgical intervention, delayed recognition of the postoperative infectious trajectory was followed by septic shock requiring intensive care and vasopressor support. This case emphasizes that, in older men with acute scrotum after urological surgery, infection and evolving sepsis should be assessed alongside torsion, even when Doppler findings suggest absent testicular perfusion.</p>