Coup-Countercoup Pattern in Pediatric Testicular Trauma: A Case Report

Testicular trauma in children is uncommon due to the testes' protected anatomical location but can result in serious complications such as hematoma, rupture, or infarction. We report a case of a 7-year-old boy who sustained blunt scrotal trauma from a bicycle accident. Ultrasound revealed a parenchymal defect with absent perfusion in the lower pole of the right testis at the site of impact, as well as a smaller lesion and subcapsular hematoma in the upper pole, opposite the point of trauma. Surgical exploration confirmed necrosis of the devascularized segment, leading to partial orchiectomy and drainage of the hematoma. The pattern of injury suggests a coup-countercoup-type mechanism, similar to that observed in traumatic brain injury, likely caused by internal displacement forces within the confined tunica albuginea. Prompt surgical intervention enabled preservation of viable testicular tissue. This case emphasizes the utility of high-resolution ultrasound in detecting complex testicular injuries and highlights the need to consider contralateral damage in pediatric blunt scrotal trauma.