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Appendicular Perforation in a Neonate Masquerading as Testicular Torsion. BACKGROUND: Neonatal appendicitis is difficult to diagnose, and is associated with high mortality. CASE CHARACTERISTICS: A preterm (33 wk) neonate developed abdominal distension feeding intolerance and erythema of left inguinal region on day 4 of life. OBSERVATION: Testicular torsion was suspected but inguinal exploration revealed normal testis with feco-purulent fluid draining into processus vaginalis from peritoneal cavity. Laparotomy revealed inflamed and perforated appendix. Appendectomy and intravenous antibiotics led to a recovery. MESSAGE: Appendicitis in a neonate can rarely present with inguinal symptoms, masquerading as testicular torsion.