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Abstract Background Scrotal pain is a common complaint in the clinical practice, with many underlying causes. Infectious causes, like epididymitis, are frequently encountered in the work-up of scrotal pain. The presentation of epididymitis is mostly mild, yet major complications can occur. Case presentation We present a 35-year-old male presenting with scrotal pain and swelling of the testicle. Epididymitis with testicular necrosis was diagnosed using repeated doppler ultrasonography measurements. An orchiectomy was performed which showed a hemorrhagic process with affected spermatic cord. Funiculitis together with epididymal swelling can impede testicular blood flow, with testicular necrosis possibly resulting in orchiectomy. This is the first case that proved funiculitis to co-exist in loss of colour doppler on pathological evaluation. Conclusions In order to reduce major complications, medical therapy should be promptly initiated when there is a suspicion of epididymitis.