Testicular Rupture: The Other Nutcracker Syndrome

Abstract

Scrotal trauma is a rare incident but when it occurs it is typically among 6 to 12 years old boys. It is most commonly unilateral secondary to compression of the scrotal contents against the pubic bone. The majority of trauma to the scrotal region is blunt impact but serious injuries are rare despite the vulnerable position of the testicles. The combination of the cremasteric reflex and mobility/strength of the tunica albuginea contribute to reducing occurrences. However, serious injury can occur when the testicle is trapped against the pubic bone, varying from minimal extravasation to complete parenchymal destruction. Testicular rupture is a rare injury characterized by rupture of the tunica albuginea resulting in exposure of the seminiferous tubules. Prompt evaluation of these patients is crucial as a delay in surgical care may lead to loss of the injured testicle. We present a case of acute testicular rupture in an active duty male followed by a review of the literature.

Keywords: Testicular diseases; infertility; male; shock; traumatic.

Figure 1.

Left testicle is noted to be edematous, swollen, erythematous with a dusky hue extending from base of penis to bottom of testicle.

Figure 2.

Ultrasound of left testicle: heterogeneous, dysmorphic left testicle with multiple large areas of internal hypoechogenicity, and a disruption of the capsule. Hypervascularity and edema within the epididymis.

Figure 3.

(a) Transverse incision over the left hemiscrotum, revealing inflamed tunica vaginalis, large defect of the tunica albuginea with protrusion of seminiferous tubules and (b) closure of tunica albuginea, viable testicle, and placed back into left hemiscrotum.