Do you need to perform an emergent orchiopexy on a patient who presents with acute onset testicular pain and scrotal ultrasound shows whirlpool sign but there is arterial flow to the testicle?

I would at least council the family/offer an urgent orchidopexy in this situation. In the practice at my hospital, we have sent someone home in this situation who came back with a non viable testis.

Chances are that they will bounce back in a short period of time so I would offer urgent surgery - bilateral septopexy