Testicular Rupture: The Other Nutcracker Syndrome

Abstract

Scrotal trauma is a rare incident but when it occurs it is typically among 6 to 12 years old boys. It is most commonly unilateral secondary to compression of the scrotal contents against the pubic bone. The majority of trauma to the scrotal region is blunt impact but serious injuries are rare despite the vulnerable position of the testicles. The combination of the cremasteric reflex and mobility/strength of the tunica albuginea contribute to reducing occurrences. However, serious injury can occur when the testicle is trapped against the pubic bone, varying from minimal extravasation to complete parenchymal destruction. Testicular rupture is a rare injury characterized by rupture of the tunica albuginea resulting in exposure of the seminiferous tubules. Prompt evaluation of these patients is crucial as a delay in surgical care may lead to loss of the injured testicle. We present a case of acute testicular rupture in an active duty male followed by a review of the literature.

Testicular Rupture Following Motorcycle Accident

“…Testicular infarction occurs approximately six hours after the onset of ischemia, thus the single most important prognostic factor for testicular salvage is time to surgical intervention [6,7]. Ultrasound findings include testicular contour irregularities, discontinuity in the tunica albuginea, and heterogeneous echotexture of the testis with possible regions of avascularity are characteristic of testicular rupture [2][3][4]8]. Disruption of the tunica albuginea by itself has a sensitivity and specificity of approximately 50% and 75%, respectively [2].…”

“…Motorcycle collisions specifically are associated with an increased risk of testicular trauma and rupture [1]. Testicular rupture is characterized as disruption of the surrounding tunica albuginea [2][3][4]. However, the presentation of symptoms is often nonspecific and generalized to the pelvic region, especially in the context of other pelvic injuries, which can result in delayed presentation and mislead diagnostic prioritization [3,5].…”

“…Testicular rupture is characterized as disruption of the surrounding tunica albuginea [2][3][4]. However, the presentation of symptoms is often nonspecific and generalized to the pelvic region, especially in the context of other pelvic injuries, which can result in delayed presentation and mislead diagnostic prioritization [3,5]. Nonetheless, ultrasonography has been found to maintain the highest degree of diagnostic sensitivity and accuracy when evaluating testicular pathologies, including testicular rupture [2,4].…”