A rare and unusual presentation: Testicular amputation with intact scrotal wall following blunt trauma - A case...

Scrotal and testicular trauma accounts for approximately 0.2 % of all trauma cases. Of these, blunt injuries constitute 85 %, with motor vehicle collisions being the predominant cause. Penetrating injuries represent 15 %, the majority (75.8 %) of which result from firearm assaults. This case is exceptional, as testicular amputation occurred without any scrotal breach-an event not previously documented in the literature, to our knowledge.

A 28-year-old male, under the influence of alcohol, presented with a history of blunt trauma following motorbike collision with a stationary car. Primary survey revealed scrotal swelling along with ecchymosis of the scrotum and suprapubic region. Scrotal ultrasonography showed non-visualization of the right testis and ∼ 200 ml of clot within the right hemiscrotum. Scrotal exploration revealed an auto-amputated right testis lying within blood clots, with active bleeding from the testicular artery. The right testis, along with blood clots, was evacuated, followed by ligation of the testicular artery and vas deferens.

Since the testicular vessels bleed heavily and retract easily, the main goal should be to save the patient's life. Testicular replantation and removal of amputated testis are the two treatment options. If patient presents within 6 hours of injury, the testis is viable, has a vascular pedicle, and expertise is available, microsurgical testicular replantation can be done.

Traumatic testicular amputation can occur even if the scrotal skin is intact and the patient is hemodynamically stable. In spite of conservative management for hematoma, it is always advised to undergo surgical exploration in such cases.