Compartment syndrome of the testicle: a case report and review of the literature

Abstract

A 22-year-old male presented with a swollen, tender right testicle. The pain was of sudden onset, having woken him that morning, and required intravenous morphine to tolerate it. He had no history of trauma, inter-current illness or new sexual partners.On examination, the scrotum was swollen, especially more so on the right hemi-scrotum. Subsequently, the right testicle was swollen and elevated, with a horizontal lie. Further elevation of the right testicle did not reduce the pain. The patient was systemically well, afebrile and on further examination, did not show signs of lymphadenopathy. Past medical history was non-contributory, and in addition, all blood tests were normal including a negative sickle screening test.Clinical examination within 40 minutes of arrival to the emergency department yielded significant, clear indications for exploratory surgery; hence the patient was immediately prepared for theatre without delaying to await ultrasound confirmation. The patient consented for a right scrotal exploration, ± right orchidectomy, ± bilateral orchi-dopexy. He was in theatre just under three hours later and remained under general anaesthetic for two hours. No anaesthetic complications were reported.A scrotal exploration was performed and an incision was made in the median raphe. The right hemi-scrotum was explored. The right testis was delivered, and was dusky in colour. No torsion was noted. An attempt to salvage the affected testicle was made by submerging it in warm sterile water for 15 minutes with gentle massage. This did not

Pressed for time: The sonographic signs of testicular compartment syndrome

“…Of all scrotal pathologies, those that cause compression of the microvasculature are the greatest of concern as ischemia lasting 8 h or greater is known to cause irreversible damage to tissue and will result in death of the testicle; requiring orchidectomy 1,7 . Therefore, TCS is regarded as a surgical emergency as diagnosis and subsequent surgical intervention to re‐perfuse the testicle is time critical 7,11,12 …”

“…Conversely; sonographically, it is common to see unilateral or bilateral hypertrophy and hyperaemia of the testes and epididymis in the setting of infective processes such as epididymitis/epididymo‐orchitis 6 . Due to these features also being present in early stage of compression from TCS, these conditions are indistinguishable without the use of spectral Doppler to detect REDF 1,11,12,14 . REDF is a high resistance flow pattern indicative of antegrade flow during systole and retrograde flow during diastole which results in a loss of tissue perfusion 12 .…”

“…1,7 Therefore, TCS is regarded as a surgical emergency as diagnosis and subsequent surgical intervention to reperfuse the testicle is time critical. 7,11,12 The use of ultrasound to aid in diagnosis of testicular pathology is well-documented and therefore its value in diagnosing TCS should be addressed. Although TCS is not yet well-recognised and the exact incidence remains unknown, it should be considered as differential when investigating common scrotal pathologies.…”

“…6 Due to these features also being present in early stage of compression from TCS, these conditions are indistinguishable without the use of spectral Doppler to detect REDF. 1,11,12,14 REDF is a high resistance flow pattern indicative of antegrade flow during systole and retrograde flow during diastole which results in a loss of tissue perfusion. 12 It is therefore critical to utilise spectral Doppler when assessing the testicles and recognise REDF as an indication of impending testicular infarction.…”