Scrotal trauma: A case report and review of the literature

Abstract

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.