Torsion of the neonatal testis is a well-recognized clinical entity, which accounts for about 10% of all cases of testicular torsion admitted to pediatric surgical centers.1 A UK study estimated the incidence of neonatal testicular torsion to be 6.1 per 100,000.2 Torsion usually occurs extravaginally, i.e., in the spermatic cord above the insertion of the tunica vaginalis (Figure 111.1), but both intravaginal and mesorchial torsion are reported. 3 , 4 Either testis may be involved. Bilateral torsion occurs and may be synchronous or metachronous. 5 , 6 Asynchronous torsion may occur in as many as 33% of cases.7Apparent primary infarction of the neonatal testis in the absence of torsion occurs less commonly,8 and while it has been postulated that this represents previous torsion that has untwisted, good evidence exists to suggest that the initial event in neonatal torsion is a vascular one and that torsion may occur secondarily.3 The neonatal testis may be prone to extravaginal torsion because of its extreme mobility within the scrotum.9