|Year : 2006 | Volume
| Issue : 1 | Page : 71-72
Traumatic dislocation of testis
Dept of Urology, St. Philomena's Hospital, Mother Teresa Road, Bangalore - 560 047, India
G-1, Aashraya Apts, 63 South Cross Road, Basavanagudi Bangalore
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Traumatic dislocation of testis occurs as a consequence of high velocity road traffic accident. We report traumatic testicular dislocation in a young man which was successfully treated with closed reduction under general anesthesia.
Keywords: Testis, traumatic dislocation
|How to cite this article:|
Vijayan P. Traumatic dislocation of testis. Indian J Urol 2006;22:71-2
An 18-year- old male was admitted following a road traffic accident. He sustained fracture of both pubic rami, dislocation of Lt. SI joint and fracture of lower ribs (Lt.)
He was resuscitated with IV fluids, blood transfusion nasogastric suction and urinary catheterisation. Antibiotics were administered.
A CT study revealed retroperitoneal hematoma, minimal intraperitoneal hemorrhage and no evidence of abdominal or thoracic visceral injury. He was put on bilateral lower limb traction. He rapidly improved in the next few days and supportive measures were discontinued. 3 weeks later he was advised to go home and to continue bed rest.
The day prior to his intended discharge, he complained that his right testis could not be located in the hemiscrotum. He was sure that both testes were in normal position, prior to the accident. An urological consultation was sought.
Examination revealed a normally developed scrotal sac and an oval mass was felt subcutaneously in the superficial inguinal pouch on the Rt. side [Figure - 1].
The CT was reviewed. An oval soft tissue mass morphologically resembling the testis was made out in the Rt. inguinal region subcutaneously. [Figure - 2]
Attempts to reposition the testis into its rightful place were painful and hence abandoned.
He was prepared for surgical exploration and orchidopexy. However, under general anesthesia closed reduction was successful. He was discharged home the following day.
When reviewed 1 month and 3 months later, both testicles were of equal size and retained normal sensation. No Doppler study was performed.
| Discussion|| |
Though first reported in 1818, dislocation of testis following blunt trauma was documented in about 60 cases so far in the available literature. 36 cases were evaluated retrospectively over a period of 22 years in Thailand. Traumatic dislocation has been the result of accidents involved while driving high-speed vehicles especially motor cycles. Associated injuries may preclude early detection and reduction of the dislocated testis.
Because of its association in a multi-trauma injury it could be a late finding in some of the cases. Awareness of this possible occurrence in the mind of those initially treating physicians cannot be overemphasized. Imaging modalities such as ultrasound and CT scan help to localize and demonstrate capsular or parenchymal damage.
The dislocation may be unilateral or bilateral.
Possible sites and reported frequency of testicular dislocation:
Superficial: Superficial Inguinal 50% Abdominal: Truly abdominal 6%
Pubic 18% Canalicular 8%
Penile 8% Acetabular 4% Crural 2%
Delays in correction may result in irreversible changes such as reduction of spermatids, decreased spermatogenesis and relative increase in Sertoli cells More Details. However, recovery followed surgical correction in the reported cases. Closed reduction is possible in some cases. Surgical reduction is recommended for the following reasons.
1. Possibility of testicular torsion or rupture
2. High incidence of failure of closed reduction.
3. Minimum morbidity associated with surgery.
Some patients may well have some predisposing factor for testicular dislocation.
The case is presented for its rarity.
| References|| |
|1.||Kochakarn W, Choonhaklai V, Hotrapawanond P, Muangman V. Traumatic testicular dislocation a review of 36 cases. J Med Assoc Thai 2000;83:208-12. [PUBMED] |
|2.||Schwartz SL, Faerber GJ. Dislocation of the testis as a delayed presentation of scrotal trauma. Urology 1994;43:743. [PUBMED] [FULLTEXT]|
|3.||Hayami S, Ishigooka M, Suzuki Y, Sasagawa I, Nakada T, Mitobe K. Pathological changes of traumatic, dislocated testis. Urol Int 1996;56:129-32. [PUBMED] |
[Figure - 1], [Figure - 2]