Scrotal trauma: A case report and review of the literature

Abstract

Scrotal trauma: A case report and review of the literature Case A healthy 25-year-old male with no medical history was evaluated by the urology service in the emergency department (ED) urgently after presenting with a chief complaint of scrotal swelling and pain. He described that he had been playing a game of baseball and was injured by direct contact between the ball and his scrotum, which immediately led to severe pain. The patient had initially deferred medical assessment, but presented to triage several hours after the initial trauma because of ongoing pain and swelling.During initial assessment, the patient was clinically stable. He denied hematuria or any other voiding symptoms. Physical examination revealed significant edema and erythema along the right hemi-scrotum. The left hemi-scrotum was unremarkable. No lacerations suggesting penetrating trauma were noted.Ultrasonography was ordered by the ED physician prior to urology consultation (Fig. 1). The radiology report revealed abnormal morphology of the right testicle, with disruption of the tunica albuginea (ruptured capsule). Additionally, there was concern for significant hematoma and extruded testicular components. After discussing the likely diagnosis of ruptured testicle, it was decided that scrotal exploration and repair or potential orchiectomy would be the best course of action, and as such, informed consent was obtained and the patient was prepared for the operating room.

Testicular dislocation: An atypical case and review of the literature

“…Testicles are relatively well protected due to: fixation by the gubernaculum to a strong capsule; the low friction sliding ability given by the lubrication that occurs between the two layers of the tunica vaginalis; the cremasteric reflex and the fibrous and tensile-resistant tunica albuginea. 1 According to Alyea et al the dislocated testis could then be displaced along a circle within the radius of the spermatic cord centered on the external inguinal ring. 4 These hypothetic locations and their reported frequency have been described by Schwartz et al 4 Testicular dislocations occurred in the superficial inguinal pouch in 50% of patients.…”

“…Genitourinary injury represents approximately 10% of cases of abdominal trauma 1 and up to 67% involve the external genitalia. 1 , 2 About 80% corresponds to blunt trauma and 20% is due to penetrating injuries.…”

“…Genitourinary injury represents approximately 10% of cases of abdominal trauma 1 and up to 67% involve the external genitalia. 1 , 2 About 80% corresponds to blunt trauma and 20% is due to penetrating injuries. 2 It is more common in males owing to anatomical differences and their involvement in high impact and energy activities.…”

“… 2 It is more common in males owing to anatomical differences and their involvement in high impact and energy activities. 1 , 2 …”

“…Testicular dislocation is a rare entity that usually goes unnoticed because of the coexistence of other severe injuries as described in a multitrauma-injured motorcyclist. 1 , 2 , 3 , 4 In most cases, treatment requires early surgical correction to reduce long-term morbidities such as infertility, testicular atrophy, testicular pain syndrome, testicular neoplasia and psychological effects. 2 , 3 , 4 …”