A 77-year-old male presented to our emergency department (ED) with a 3-hour history of acute severe lower abdominal pain, inability to void, a swollen scrotum, and one episode of vomiting. His relevant past medical history included: hypertension, diabetes mellitus, and distant right inguinal hernia repair. Vital signs were: 96.4° F, 101, 22, and 205/90. Examination revealed a…