# Unilateral testicular rupture after blunt scrotal trauma: A case report and literature review

## TL;DR

A 57-year-old man with delayed testicular rupture after blunt trauma highlights the importance of early diagnosis and surgery to prevent complications.

## Contribution

This case report adds a rare clinical example of delayed unilateral testicular rupture following blunt scrotal trauma.

## Key findings

- Delayed presentation of testicular rupture after blunt trauma can lead to orchiectomy if not promptly diagnosed.
- AAST grade V rupture was confirmed intraoperatively with necrotic tissue and extruded seminiferous tubules.
- Early surgical intervention improved outcomes in this case of atypical testicular trauma presentation.

## Abstract

Testicular trauma, accounting for up to 66 % of urological injuries, mainly affects males aged 15 to 40 due to sports, violence, and traffic accidents. Rupture occurs in 48 % to 60 % of blunt injuries, often involving the right testis. Early ultrasonographic diagnosis and prompt surgical exploration are vital to prevent complications, infertility, or orchiectomy.

A 57-year-old man presented with a three-month history of right-sided scrotal swelling following blunt perineal trauma from a fall. Initial treatment with analgesics and antibiotics from lower level health facilities relieved pain but not swelling. Examination revealed a non-tender, irreducible right scrotal mass with a non-palpable right testis. Ultrasound showed a large, mixed-echo fluid collection with increased peripheral vascularity. Laboratory results were normal. A differential diagnosis of scrotal haematoma versus abscess was made, prompting surgical exploration. Intraoperatively, a 150 mL old haematoma and a ruptured right testis (AAST grade V) with torn tunica albuginea, extruded seminiferous tubules, and necrotic tissue were found. A right orchiectomy and debridement were performed. Hemostasis was achieved, and layered closure of the scrotum was completed using absorbable sutures. The postoperative course was uneventful, and at one-month follow-up, the patient had recovered well. Early evaluation and surgical intervention were key to an optimal outcome in this case of delayed testicular rupture.

Blunt testicular trauma, although rare, requires early ultrasonographic assessment and immediate surgical exploration to maximise testicular salvage and minimise orchiectomy rates. Ruptures often occur from sports or falls, with atypical presentations making diagnosis more difficult. The AAST grading system informs treatment, and early intervention enhances fertility, hormonal function, and psychosocial outcomes.

Testicular rupture is uncommon but serious, requiring prompt assessment to optimise testicular preservation, especially in high-risk patients.

•The patient experienced blunt trauma to the scrotum following a fall, resulting in persistent swelling on the right side of the scrotum for three months.•Initial treatment with analgesics and antibiotics alleviated pain but did not reduce the swelling, leading to a referral to a higher-level facility.•Examination revealed a non-tender, irreducible, non-transilluminant right scrotal mass with a non-palpable right testis.•Ultrasound showed a large, heterogeneous fluid collection suggestive of a haematoma, raising suspicion of an abscess or testicular rupture.•Surgical exploration confirmed a ruptured right testis (AAST grade V) with necrosis, resulting in orchiectomy and debridement, followed by an uneventful recovery.

The patient experienced blunt trauma to the scrotum following a fall, resulting in persistent swelling on the right side of the scrotum for three months.

Initial treatment with analgesics and antibiotics alleviated pain but did not reduce the swelling, leading to a referral to a higher-level facility.

Examination revealed a non-tender, irreducible, non-transilluminant right scrotal mass with a non-palpable right testis.

Ultrasound showed a large, heterogeneous fluid collection suggestive of a haematoma, raising suspicion of an abscess or testicular rupture.

Surgical exploration confirmed a ruptured right testis (AAST grade V) with necrosis, resulting in orchiectomy and debridement, followed by an uneventful recovery.