Acute pancreatitis presenting with scrotal swelling and tenderness is rare. It is caused by fat necrosis of soft tissue at the scrotum due to accumulation of pancreatic fluid. With similar symptoms to testicular torsion, case management strategies are quite different. Acute scrotum owing to testicular torsion requires emergency exploration while conservative treatment is adequate for the latter. A correct diagnosis is very important to give appropriate treatment and avoid unnecessary an operation. Here, we present our case and review the related historical literature.