Today’s Trauma Tuesday POTD is about a rare but dangerous type of straddle injury in males: testicular dislocation.
Most commonly found in young males involved in a decelerating motorcycle accident, testicular dislocation presents with severe unilateral or bilateral scrotal and/or inguinal pain. Because there may be multiple other distracting injuries incurred as a result of the accident, a genitourinary exam will be vital in identifying this injury.
On exam, you will find that the testicle has been dislocated from its normal home in the scrotum to another location due to blunt force tearing the fascia of the spermatic cord. Half of the time, that location is the inguinal pouch, and you may find a palpable mass representing the testis at the inguinal crease. The corresponding hemiscrotum will be empty. Interestingly, unilateral and bilateral testicular dislocation appears to occur at the same rate, so don’t forget to check the other side as well. Other locations the dislocated testis may end up are the penis, the perineum, and the abdomen.
Manual reduction may be attempted but is often limited by intractable pain and therefore infrequently successful. There also may be concomitant torsion. Emergent urology consult for operative intervention is usually indicated.
Prolonged dislocation may affect fertility and increases the risk of testicular malignancy in the future
Sources:
Zavras N, Siatelis A, Misiakos E, Bagias G, Papachristos V, Machairas A. Testicular Dislocation After Scrotal Trauma: A Case Report and Brief Literature Review. (2014) Urology case reports. 2 (3): 101-4.
S. L. Schwartz, G. Faerber. Dislocation of the testis as a delayed presentation of scrotal trauma. (1994) Urology.