INJURIES TO SCROTAL CONTENTS BY BLUNT TRAUMA JOHN F. REDMAN, GLEN A. ROUNTREE, NABIL K. BISSADA,
M.D. M.D. M.D.
From the Division of Urology, University of Arkansas Medical Center, Little Rock, Arkansas
ABSTRACT - Three unusual injuries to the scrotal contents following blunt trauma are reported. Early surgical exploration is recommended when signijcant ecchymosis or a hydrocele follows blunt scrotal trauma.
Three consecutive scrotal explorations in a ninemonth period following blunt trauma provided identification of three different unusual injuries to the scrotal contents. Case Reports Case 1 A ten-year-old black male was evaluated in August, 1974, at Arkansas Children’s Hospital
twelve hours after a fall from his front porch. He presented with an enlarged, painful right hemiscrotum with obvious ecchymosis. On exploration the epididymis was noted to be avulsed from the testicle. The tear extended from the globus major to the midportion of the testicle. The epididymis was lacerated at the juncture of the upper and middle thirds. A moderate-sized hematocele was present. The upper one third of the epididymis was resected.
FIGURE 1. operation; varix and varices. (B)
190
UROLOGY
Case 3. (A) Gross appearance at hemostat demonstrates rent in arrow indicates remainder of Detail of rent in varix.
I
FEBRUARY
1976 / VOLUME
VII,
NUMBER 2
Case 2
Comment
A fourteen-year-old black male was evaluated at Arkansas Children’s Hospital in February, 1975, fourteen days following blunt trauma to the scrotum while wrestling. He had been seen on the day of injury by his physician who noted that the testicle was normal to palpation with only mild tenderness. On admission to the urology service a large hematocele was present. The patient was otherwise asymptomatic. On exploration 120 cc. of serosanguineous fluid was evacuated. The testicle was lacerated transversely across the entire width of the organ. The bulging testicular tissue was resected sharply, and the tunica albuginea was closed. The resected tissue microscopically showed infarction and atrophy.
4301 West Markham Street Little Rock, Arkansas 72201 (DR. REDMAN) References
Case 3 A thirty-five-year-old white male was admitted to the University Hospital in April, 1975, with acute scrotal swelling and intense ecchymosis of two hours’ duration. Blunt trauma to the scrotum resulted from a kick. Scrotal exploration demonstrated a large hematoma between the internal spermatic fascia and the tunica vaginalis. A varicocele was noted, and a laceration of one of the large varices was identified as the site of bleeding (Fig. 1).
UROLOGY /
Rupture of the testicle following blunt trauma has been reported approximately fifty times.‘-” The presentation as well as the surgical management has been well reviewed.5 Generally the principle of the immediate surgical exploration of all patients with traumatic hydroceles provides the greatest opportunity for the diagnosis and salvage of ruptured testicles. A laceration of the epididymis following blunt trauma has been reported only one previous time.6 The laceration of a varicocele by blunt trauma has not been reported previously.
FEBRUARY 1976 /
VOLUME VII, NUMBER 2
1. TALARICO,R. D., and CLARK, J. C.: Non-penetrating testicular rupture, Urology 1: 365 (1973). 2. WASKO,R., and GOLDSTEIN, A. G. : Traumatic rupture of the testicle, J. Urol. 95: 721 (1966). 3. MERRICKS,J. W., and PAPIERNIAK,F. B.: Traumatic rupture of the testicle, ibid. 103: 77 (1970). 4. MCCORMACK,J. L., KRETZ, A. W., and TOCANTINS R.: Traumatic rupture ofthe testicle, ibid. 96:80(1966). 5. GROSS, M.: Rupture of the testicle: the importance of early surgical treatment, ibid. 101: 196 (1969). 6. ASHKAR, L. N., and SCHRECK, W. R.: Traumatic rupture of the testis and epididymis, ibid. 99: 774
(1968).
191
M.D. M.D. M.D.
From the Division of Urology, University of Arkansas Medical Center, Little Rock, Arkansas
ABSTRACT - Three unusual injuries to the scrotal contents following blunt trauma are reported. Early surgical exploration is recommended when signijcant ecchymosis or a hydrocele follows blunt scrotal trauma.
Three consecutive scrotal explorations in a ninemonth period following blunt trauma provided identification of three different unusual injuries to the scrotal contents. Case Reports Case 1 A ten-year-old black male was evaluated in August, 1974, at Arkansas Children’s Hospital
twelve hours after a fall from his front porch. He presented with an enlarged, painful right hemiscrotum with obvious ecchymosis. On exploration the epididymis was noted to be avulsed from the testicle. The tear extended from the globus major to the midportion of the testicle. The epididymis was lacerated at the juncture of the upper and middle thirds. A moderate-sized hematocele was present. The upper one third of the epididymis was resected.
FIGURE 1. operation; varix and varices. (B)
190
UROLOGY
Case 3. (A) Gross appearance at hemostat demonstrates rent in arrow indicates remainder of Detail of rent in varix.
I
FEBRUARY
1976 / VOLUME
VII,
NUMBER 2
Case 2
Comment
A fourteen-year-old black male was evaluated at Arkansas Children’s Hospital in February, 1975, fourteen days following blunt trauma to the scrotum while wrestling. He had been seen on the day of injury by his physician who noted that the testicle was normal to palpation with only mild tenderness. On admission to the urology service a large hematocele was present. The patient was otherwise asymptomatic. On exploration 120 cc. of serosanguineous fluid was evacuated. The testicle was lacerated transversely across the entire width of the organ. The bulging testicular tissue was resected sharply, and the tunica albuginea was closed. The resected tissue microscopically showed infarction and atrophy.
4301 West Markham Street Little Rock, Arkansas 72201 (DR. REDMAN) References
Case 3 A thirty-five-year-old white male was admitted to the University Hospital in April, 1975, with acute scrotal swelling and intense ecchymosis of two hours’ duration. Blunt trauma to the scrotum resulted from a kick. Scrotal exploration demonstrated a large hematoma between the internal spermatic fascia and the tunica vaginalis. A varicocele was noted, and a laceration of one of the large varices was identified as the site of bleeding (Fig. 1).
UROLOGY /
Rupture of the testicle following blunt trauma has been reported approximately fifty times.‘-” The presentation as well as the surgical management has been well reviewed.5 Generally the principle of the immediate surgical exploration of all patients with traumatic hydroceles provides the greatest opportunity for the diagnosis and salvage of ruptured testicles. A laceration of the epididymis following blunt trauma has been reported only one previous time.6 The laceration of a varicocele by blunt trauma has not been reported previously.
FEBRUARY 1976 /
VOLUME VII, NUMBER 2
1. TALARICO,R. D., and CLARK, J. C.: Non-penetrating testicular rupture, Urology 1: 365 (1973). 2. WASKO,R., and GOLDSTEIN, A. G. : Traumatic rupture of the testicle, J. Urol. 95: 721 (1966). 3. MERRICKS,J. W., and PAPIERNIAK,F. B.: Traumatic rupture of the testicle, ibid. 103: 77 (1970). 4. MCCORMACK,J. L., KRETZ, A. W., and TOCANTINS R.: Traumatic rupture ofthe testicle, ibid. 96:80(1966). 5. GROSS, M.: Rupture of the testicle: the importance of early surgical treatment, ibid. 101: 196 (1969). 6. ASHKAR, L. N., and SCHRECK, W. R.: Traumatic rupture of the testis and epididymis, ibid. 99: 774
(1968).
191
