Injury (1993)
24,
(2), 129
Printedin Great Britain
129
Case reports
Traumatic dislocation of the testicle K. U. Wright Department
and P. J. Gibbons
of Surgery, Royal Hospital, Wolverhampton,
UK
Introduction Traumatic dislocation of the testicle is rare. Fifty cases have been reported in the world literature. We present a case where the diagnosis was missed initially, and discuss the management of such patients.
Case report A 35-year-old man was admitted following a road traffic accident during which he had been thrown from his motorcycle. On admission there was pelvic pain on compression associated with oedema and gross bruising of the perineum. This was noted by three different clinicians, one of whom were able to detect any testicular abnormality. Radiographs confirmed separation of the symphysis pubis and disruption of the left sacroiliac joint. He was treated initially by resuscitation and bed rest. Nine days later, after resolution of a paralytic ileus, a Hoffman-Day frame external fixator was applied to treat the pelvic injury. He made a good recovery and was discharged 1 week later mobilizing touch weight bearing with crutches. He was readmitted 5 weeks later for removal of the external fixator and at this stage complained of pain in the groin associated with absence of the right testicle, which was confirmed by clinical examination. He was referred to a consultant urologist and shortly afterwards was admitted for exploration of the right inguinal region. At operation an apparenly normal testicle was discovered adjacent to the superficial inguinal ring and routine orchidopexy was carried out. Pain had begun to diminish within 24 h postoperatively and had resolved completely within I week.
Traumatic dislocation of the testicle was first described by Claubry in 1818. Since then, 50 cases have been described in the world literature (Singer et al., 1990). The commonest site for dislocation is the superficial inguinal pouch. Other sites include pubic, penile, preputial, perineal, crural and deep inguinal regions (Morgan, 1965). The dislocation is bilateral in one-third of cases. Dislocation is usually the result of blunt perineal trauma arid is commonly associated with pelvic fractures. Symptoms usually include extreme pain and nausea, and the signs are of a tender, dislocated testicle and 0020-1383/93/020129-01
Acknowledgements We would like to thank Mr L. L. Beynon
for his permission
to report this case.
References Morgan A. (1965)
Traumatic luxation of the testicle. Br.J Surg.52,
669.
Discussion
(0 19% Buttenuorth-Heinemann
an empty scrotum. However, a scrotal haematoma may mask the dislocation, as in this case (Neistadt, 1967). Treatment has included attempts at closed reduction, although this has only been successfuul in 14 per cent of cases. It has been advocated that this is performed 3-4 days after injury to allow oedema to subside. Most require open reduction. The duration of dislocation has varied from 12 h to 25 years, and repositioning the testicle usually provides immediate symptomatic relief. Long-term function in those cases where reduction is delayed has not been fully evaluated. Ultrasound examination has been proposed to assess those injuries which may include parenchymal rupture which would require open surgical repair. This case demonstrates the difficulty in making the diagnosis of testicular dislocation when there is marked scrotal swelling and bruising. Clinicians should be aware of the possibility of testicular dislocation in such cases, and we suggest that if both testes cannot confidently be demonstrated to lie within the scrotum then ultrasonography should be performed to locate them.
Ltd
Neistadt A. (1967) Bilateral traumatic dislocation of the testicle. 1. Urol. 97, 1057. Singer A. J., Das S. and Gavrell G. J. (1990) Traumatic dislocation of the testicle. LlroIogy 35, 310.
Paper accepted
14 April 1992.
Requesfs for reprints shouti be addressedfoe: Mr K. U. Wright, Department of Orthopaedic Surgery, North Tees General Hospital, Hardwick, Stockton-on-Tees, Cleveland TSl9 SPE, UK.