Importance of Early Exploration in Blunt Scrotal Trauma

Lee, Dong Hwan; Suh, Hong Jin; Nam, Bong Hyeon

Abstract

Early diagnosis and prompt surgical exploration in blunt scrotal trauma is mandatory to save the affected testis and decrease the morbidity. We reviewed 25 cases of blunt scrotal trauma evaluated with ultrasonography as a result of violence, sports, traffic accident from March, 1989 to February, 1997. The right side was affected slightly more often than the left side. Sonography identified scrotal hematocele in 21 out of 25 cases and 4 cases had no evidence of scrotal hematocele. In 7 out of 21 cases with scrotal hematocele, ultrasonography showed rupture sites of the tunica albuginea (5) and intratesticular radiolucency displacing the normal echogenicity of the testicular parenchyina (2). In the other 14 cases ultrasonography showed no evidence of rupture. In 4 cases without scrotal hematocele, one was diagnosed as traumatic orchitis due to testicular enlargement and two had focal intratesticular hematoma so that these cases didn't undergo explorations. And 1 case had rupture of the tonics albuginea combined with testicular torsion at the time of exploration. Surgical explorations were performed in 19 (76.0%) out of 25 cases, who showed definitive rupture sites of the tunica albiginea (8), large hematoma and/or persistent severe pain without being seen rupture sites of the tunica albuginea (11) on ultrasonography and their operative methods were orchiectomy in 9 (36.0%), evacuation of the hematocele in 6 (24%), partial orchiectomy in 2 (8.0%) and simple closure of the tunica in 2 cases (8.0%). There was a direct relationship between salvageability and early surgery. In 13 out of 19 cases who underwent explorations within 3 days after trauma, the surgical managements comprised evacuation of the hematocele in 5 (38.5%), orchiectomy in 4 (30.8%), partial orchiectomy in 2 (15.4%), and simple closure of the tunica in 2 cases (IS.4%). However, in 6 cases who underwent explorations 4 days later after trauma, the surgical managements comprised orchiectomy in 5 (83.3%) and evacuation of the hematoma in 1 case (16.7%). In comparison with operative findings, 5 of the 14 cases, in which ultrasonography showed large hematocele without rupture of the tunica, had rupture of the tunica. Also, 7 cases, in which ultrasonography showed rupture of the tunica, all had rupture of the tonics. All patients with a history of blunt scrotal trauma, followed by a large hematocele without lure of the tunica or severely distorted testis on ultrasonography should have early surgical exploration to exclude injury to the testicle. A delayed treatment decreases the salvage rate due complications, such as ischemic necrosis and severe inflammatory reaction.