A case of unilateral torsion of the spermatic cord in a newborn is reported. Extra-vaginal neonatal torsion of the spermatic cord, although rare, is being recognized with increasing frequency. Treatment requires immediate surgical exploration. Controversy exists concerning the urgency of exploration as well as the need for contralateral orchiopexy, since some reports suggest that the contralateral testicle is not a risk for torsion. Treatment of the ipsilateral testicle is determined by operative findings.