Acute Scrotum Following Traumatic Spermatic Cord Hematoma: A Case Report and Review

Abstract

Acute scrotum constitutes the most common urological emergency secondary to spermatic cord torsion, testicular trauma, orchiepididymitis and hernias. We report a very rare case of unique traumatic spermatic cord hematoma following scrotum injury occurred during a football match. Clinical exam showed an increased volume of the left spermatic cord; the color Doppler ultrasound (CDU) demonstrated left testicular ischemia secondary to a large spermatic cord hematoma that needs surgical exploration. Spermatic cord hematoma rarely induces acute scrotum, however it could be treated conservatively surgery is mandatory when pain is persistent or testicular ischemia is confirmed by CDU.

Sneeze and pop: a ruptured varicocele; analysis of literature, guided by a well-documented case-report

“…Existing literature describes various activities preceding a spontaneous scrotal hematoma, reviewed in Table 1. Examples are pressure during defecation [4, 7, 9, 11], sexual intercourse [13], blunt abdominal trauma [5, 8, 14], heavy lifting [6], stretching in tight pants [15] or after fighter-pilot centrifuge training [19]. Another patient had a spontaneous hematoma after playing the saxophone [10].…”

“…Diagnosing a cause of acute scrotal pain and swelling can be difficult, and as stated the differential diagnosis should include conditions such as testicular torsion, malignancy, epididymo-orchitis, or (incarcerated) inguinal hernia [6, 14].…”

“…Additional arguments for exploration are possible future complications, i.e. testicular ischaemia due to obstruction of the hematoma on the funiculus [14], possible hematoma infection, or no regression in size of the hematoma. Eventually, microscopic ligation/embolisation of the varicocele can be performed [7, 9].…”

“…Direct exploration at presentation was performed in eight patients (44%). Reasons of direct exploration were uncertain diagnosis (63%) [4, 8, 12, 16, 18], suspected incarcerated inguinal hernia [10], or persisting pain [14, 20]. In the two patients, delayed exploration was performed due to no improvement of symptoms, or ischemia of the left testis [3, 6].…”

Severe testicular rupture treatment by using with tunica vaginalis flap

“…Ayrıca orşiyektomi yapılma ihtimalinin de fazla olması sebebiyle testis rüptürü olan hastalarda konservatif yaklaşım uygun değildir [3]. Bununla birlikte sunulan olguda da olduğu gibi skrotumda oluşan hematomun spermatik korda bası yapması sebebiyle testisin kanlanması azalabilir ya da tamamen durabilir [5]. Bu sebeple skrotal travmaya bağlı testis rüptürü saptanan hastalarda erken cerrahi eksplorasyonla hematom boşaltılmalı ve spermatik kord serbestleştirilmelidir.…”