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You have been asked to see a 14-year-old boy in A&E who has presented with scrotal pain and swelling. During the history, the patient reports that the pain came on suddenly, is in the left testicle only and that he has vomited three times since the pain came on an hour and a half ago. You examine the scrotum and note that the cremasteric reflex is absent. What is the most likely diagnosis?
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