Epididymitis and epididymo-orchitis are an uncommon causes of acute testicular pain in neonatal boys, epididymo-orchitis is infection or inflammation of epididymis and testis it's may be associated with urinary tract infections or reflux of urine predisposed by an underlying vasal anomaly. Pediatricians should examine the testicles meticulously after a baby is born.We report a 7 day-old boy with urinary malformations (ureteral duplication, ureterocel and right hydro-ureteronephrosis) who presented with acute scrotum. The ultrasonography exploration of the testis showed findings consistent with epididymo-orchitis, confirmed by the needle scrotal aspiration of the pus. Further radiological investigations of urinary tract showed the multiples malformations. Epididymo-orchitis should be suspected initially with abnormal physical signs and laboratory findings. Prompt prescription of antibiotics is mandatory, and appropriate therapeutic measures (antibiotics) should be undertaken to prevent recurrences and sequelae.