Case report: Traumatic unilateral testicular rupture

Testicular trauma is classified aetiologically as blunt, penetrating or degloving. Blunt testicular trauma, caused by interpersonal violence, sporting injuries and RTAs account for the majority of cases, typically affecting males aged 15-40 [1]. Approximately 98.5% of blunt trauma resulted in unilateral testicular injury; about 12-15% involving cyclists or motorcyclists (Cass and Luxenberg, 1988) [2].

A 48-year-old male motorcyclist presented to the accident and emergency department with an acute scrotum following collision with an oncoming vehicle. On arrival, he was fully conscious, tachycardic and hypertensive. Examination of his genitalia revealed ecchymosis of the right hemi-scrotum and perineal bruising. The right hemi-scrotum was grossly swollen but the left testis was normal. Ultrasound revealed gross haematoma and ruptured capsule of the right testicle. Intraoperatively, emergency exploration of the right hemiscrotum revealed evidence of lower pole rupture. Clot evacuation and debridement of necrotic testicular tissue preceded closure of the tunica albuginea.

The majority of all testicular ruptures are diagnosed secondary to sport-related injuries [3] and motor vehicle or motorbike accidents. However, analysis of the literature has revealed a total of five cases of rupture, which have been linked to testicular tumours, the most recent of which was reported in 2014 (Lunawat et al., 2014) [5]. In two out of these five cases, trivial trauma preceded the diagnosis. It raises the question whether the presence of malignancy decreases the threshold of suffering a blunt testicular injury hence increasing the likelihood of testicular rupture.

Emergency assessment and diagnosis as well as scrotal exploration are important components of the management of acute testicular rupture. Analysis of the literature proves that timely surgical intervention is crucial; early intervention results in higher rates of preservation and avoids the need for an orchidectomy.