Management of perinatal torsion varies between centers from urgent surgical exploration and contralateral fixation to conservative nonoperative management. We present a case of paratesticular abscess in a neonate mimicking a perinatal torsion which may influence management of this condition in some cases. Management of perinatal torsion varies between centers from urgent surgical exploration and contralateral fixation to conservative nonoperative management. We present a case of paratesticular abscess in a neonate mimicking a perinatal torsion which may influence management of this condition in some cases.