A 14-year-old male presents to the emergency department with nausea, vomiting, and acute onset severe right scrotal pain that started 90 minutes ago while playing soccer. He vomited once soon after pain onset. He denies any trauma. He had a similar past episode 1 year ago that resolved spontaneously 10 minutes after onset. On physical examination, his temperature is 100F, his right testicle is exquisitely tender to palpation, high riding, and fixed in the scrotum. The left testis is normal lying and non-tender with smooth contours. Right cremasteric reflex is absent.