Conservative management of bilateral traumatic testicular dislocation in a 10-year-old boy

Abstract

A 10-year-old boy fell from a one-meter-high Jacuzzi ladder in a hot spring facility, landing in a straddle position, and injured his perineum. He visited the emergency room of our hospital immediately after the injury. Magnetic resonance imaging (MRI) revealed a tear of the corpus spongiosum urethra, and compression due to a hematoma. With the hematoma spreading to the scrotum, the testes became inverted and dislocated to the inguinal region on both sides. Without surgery or interventions, the testes descended into the scrotum on the third day after the injury before fibrillation and scarring began. Testicular dislocation by injury is rare and encountered exclusively in children. It is generally treated with surgery to retain testicular function. We selected conservative management, as our patient had a closed injury without testicular torsion, and the testicular dislocation was associated with compression by hematoma, which could possibly recover with regression of the hematoma.

Traumatic testicular dislocation

“…Some cases of testicular dislocation are treated with conservative treatment (e.g., observation or manual reduction); [ 7 , 12 ] however, surgical orchidopexy is needed in most cases and is recommended as the preferred initial treatment due to failure of closed reduction, the possibility of torsion, or difficulty to locate the ruptured testis. [ 6 ]…”

“…[10,11] Additionally, the pelvis has the highest incidence rate of missed injury, and clinically significant missed injury (defined as the Abbreviated Injury Scale ≥ 2) is significantly associated with pelvic injury (hazard ratio, 2.19). [10] Some cases of testicular dislocation are treated with conservative treatment (e.g., observation or manual reduction); [7,12] however, surgical orchidopexy is needed in most cases and is recommended as the preferred initial treatment due to failure of closed reduction, the possibility of torsion, or difficulty to locate the ruptured testis. [6] We searched PubMed and reviewed some case reports or case series with the keyword "testicular dislocation" from January 1965 until August 2021(Table 1).…”

“…Matzek and Linklater [38] 1 Blunt abdominopelvic injury PE, US 33 Meena et al [39] 1 MA PE, US 34 Zavras et al [40] 1 Falling astride on a crossbar PE, US 35 Gómez et al [41] 7 6 MAs 1 pelvic crush injury PE, US, autopsy(2) 36 Pesch and Bradin [42] 1 Straddle injury US 37 Wiznia et al [43] 1 MA PE, US 38 Kim et al [44] 1 construction accident CT 39 de Carvalho et al [6] 1 MA PE, US 40 Shirono et al [12] 1 Falling down US, MRI 41 Middleton et al [45] 2 M A C T 42 Riaza Montes et al [3] 1 Uncertain (alcohol abuse) PE, US 43 Bernhard et al [46] 1 MA During OP 44…”