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Traumatic Rupture of the Testicle
TRAUMATIC RUPTURE OF THE TESTICLE FEDOR L. SENGER, JOHN J. BOTTONE
AND
WILLIAM F. ITTNER
From the Department of Urology, The Long Island College Hospital and The Long Island College of Medicine, Brooklyn, N. Y.
Traumatic rupture of the testicle, aside from those cases associated with penetrating wounds of the scrotum, is rare. The subject has been reviewed by Counseller and Pratt and, subsequently, by Wesson who, in a detailed report and thorough review of this entity, finds that only 8 cases have been reported, to which series Wesson adds I of his own. One other case by Sejournet not included in Wesson's review, has also been reported, bringing the total number of hitherto reported cases to 10. ·within the past 5 years, 2 cases of traumatic rupture of the testicle were seen at the Long Island College Hospital, and are reported herewith: CASE REPORTS
Case 1. R. H., a 28 year old West Indian Merchant Marine sailor, was brought to the accident room of the Long Island College Hospital on May 24, 1941. He did not speak English but an interpreter stated that the man had been kicked in the scrotum in a fight, which occurred about 2 hours prior to admission. The scrotum began to swell immediately and when he ·was first seen by us in the accident room, it was about 3 times its normal size, and was markedly tender on the left side. No structures were identified within the left side as it ·was so tense that the folds were obliterated. There was also tenderness in the left inguinal region and the cord. The right side of the scrotum was less tense and the right testicle was easily identified. The presumptive diagnosis was hematocele with superficial hematoma. Laboratory findings: The blood chemistry was normal; hemoglobin 84 per cent. The blood Wasserman was 4 plus. The urinalysis was negative except for occasional red blood cells. There was a slight increase in the amount of swelling for the patient's first two hospital days. The hematoma became more definite and extended to the abdominal wall on the left. The left side of the penis was also swollen, apparently from underlying blood. For the first 2 days, the patient ·was unable to void and was catheterized as necessary, which procedure was believed to explain the presence of red cells in the urine. On the fifth hospital day, a linear incision was made into the left side of the scrotum. Within the tunica vaginalis a hematoma of hard, clotted blood was found. The testicle was found within this clot and was seen to be completely torn in several areas. A complete orchidectomy was done. Postoperative course was uneventful. Anti-luetic therapy was begun on the fifteenth postoperative day and the patient was discharged, ambulatory, to the luetic clinic on the twenty-fifth postoperative day. 451
452
F. L. SENGER, J. J. BOTTONE AND W. F. ITTNER
Case 2. C. N., a 16 year old white American truck helper, was first seen in the accident room of the Long Island College Hospital on October 6, 1946, with a history of having gone horse back riding the day previously. As he attempted to mount the horse, he was kicked in the scrotum on the right side. He felt immediate severe pain and went home and to bed. The next day he noticed moderate swelling and tenderness, although he did not complain of much pain. He was advised, when first seen by us, to apply ice packs, to rest in bed and to return to the clinic for follow-up. He was again seen in the clinic on October 9, 1946, at which time the scrotum appeared a little larger. The tenderness and subjective symptoms remained the same. The scrotal swelling did not trans-illuminate. A presumptive diagnosis of hematocele was made and the patient was admitted for operation. The blood chemistry and serology were normal. The urinalysis showed no pus or red blood cells. On October 10, 1946 an incision was made into the middle third of the scrotum and carried down to the tunica vaginalis which, when opened, was seen to contain many clots. After these clots had been removed and the testicle exposed, the latter was seen to be the site of an almost complete transverse tear. The epididymis was normal. The testicle was removed and the epididymis left in situ. The tunica was then excised to within¼ inch of its attachment and a continuous plain suture was taken to insure hemastasis. The wound was drained. Postoperatively, the patient was placed on penicillin, 40,000 units every 3 hours for 4 days. The drain was removed on the third day, postoperatively, and the patient discharged on the sixth postoperative day. He was seen at the clinic once weekly for 3 weeks and then discharged. The wound was completely closed and the patient was asymptomatic. SUMMARY
To the series of reported cases of traumatic rupture of the testicle, 2 cases are reported and discussed in detail. There are three similarities in these cases that we should like to emphasize: There was no shock evident in either case. The preoperative diagnosis in both instances was hematocele. Orchidectomy was done in both cases and postoperative recovery was uneventful. REFERENCES EISENDRATH, D. N. AND RoLNICK, H. C.: Urology. Philadelphia: J. B. Lippincott Co., 1938, 4th ed., p. 411 SEJOURNET, P.: Bull. et mem. Soc. d. Chirurgiens de Paris, 35: 101, 1944. WEssoN, M. B.: J. Urol., 52: 334--337, 1944. WESSON, M. B.: Urol & Cutan. Rev., 50: 16-19, 1946. YouNG, H. H. ANDDAvrs, D. M.: Young's Practice of Urology. Philadelphia:W. B. Saunders Co., 1926, p. 167.
AND
WILLIAM F. ITTNER
From the Department of Urology, The Long Island College Hospital and The Long Island College of Medicine, Brooklyn, N. Y.
Traumatic rupture of the testicle, aside from those cases associated with penetrating wounds of the scrotum, is rare. The subject has been reviewed by Counseller and Pratt and, subsequently, by Wesson who, in a detailed report and thorough review of this entity, finds that only 8 cases have been reported, to which series Wesson adds I of his own. One other case by Sejournet not included in Wesson's review, has also been reported, bringing the total number of hitherto reported cases to 10. ·within the past 5 years, 2 cases of traumatic rupture of the testicle were seen at the Long Island College Hospital, and are reported herewith: CASE REPORTS
Case 1. R. H., a 28 year old West Indian Merchant Marine sailor, was brought to the accident room of the Long Island College Hospital on May 24, 1941. He did not speak English but an interpreter stated that the man had been kicked in the scrotum in a fight, which occurred about 2 hours prior to admission. The scrotum began to swell immediately and when he ·was first seen by us in the accident room, it was about 3 times its normal size, and was markedly tender on the left side. No structures were identified within the left side as it ·was so tense that the folds were obliterated. There was also tenderness in the left inguinal region and the cord. The right side of the scrotum was less tense and the right testicle was easily identified. The presumptive diagnosis was hematocele with superficial hematoma. Laboratory findings: The blood chemistry was normal; hemoglobin 84 per cent. The blood Wasserman was 4 plus. The urinalysis was negative except for occasional red blood cells. There was a slight increase in the amount of swelling for the patient's first two hospital days. The hematoma became more definite and extended to the abdominal wall on the left. The left side of the penis was also swollen, apparently from underlying blood. For the first 2 days, the patient ·was unable to void and was catheterized as necessary, which procedure was believed to explain the presence of red cells in the urine. On the fifth hospital day, a linear incision was made into the left side of the scrotum. Within the tunica vaginalis a hematoma of hard, clotted blood was found. The testicle was found within this clot and was seen to be completely torn in several areas. A complete orchidectomy was done. Postoperative course was uneventful. Anti-luetic therapy was begun on the fifteenth postoperative day and the patient was discharged, ambulatory, to the luetic clinic on the twenty-fifth postoperative day. 451
452
F. L. SENGER, J. J. BOTTONE AND W. F. ITTNER
Case 2. C. N., a 16 year old white American truck helper, was first seen in the accident room of the Long Island College Hospital on October 6, 1946, with a history of having gone horse back riding the day previously. As he attempted to mount the horse, he was kicked in the scrotum on the right side. He felt immediate severe pain and went home and to bed. The next day he noticed moderate swelling and tenderness, although he did not complain of much pain. He was advised, when first seen by us, to apply ice packs, to rest in bed and to return to the clinic for follow-up. He was again seen in the clinic on October 9, 1946, at which time the scrotum appeared a little larger. The tenderness and subjective symptoms remained the same. The scrotal swelling did not trans-illuminate. A presumptive diagnosis of hematocele was made and the patient was admitted for operation. The blood chemistry and serology were normal. The urinalysis showed no pus or red blood cells. On October 10, 1946 an incision was made into the middle third of the scrotum and carried down to the tunica vaginalis which, when opened, was seen to contain many clots. After these clots had been removed and the testicle exposed, the latter was seen to be the site of an almost complete transverse tear. The epididymis was normal. The testicle was removed and the epididymis left in situ. The tunica was then excised to within¼ inch of its attachment and a continuous plain suture was taken to insure hemastasis. The wound was drained. Postoperatively, the patient was placed on penicillin, 40,000 units every 3 hours for 4 days. The drain was removed on the third day, postoperatively, and the patient discharged on the sixth postoperative day. He was seen at the clinic once weekly for 3 weeks and then discharged. The wound was completely closed and the patient was asymptomatic. SUMMARY
To the series of reported cases of traumatic rupture of the testicle, 2 cases are reported and discussed in detail. There are three similarities in these cases that we should like to emphasize: There was no shock evident in either case. The preoperative diagnosis in both instances was hematocele. Orchidectomy was done in both cases and postoperative recovery was uneventful. REFERENCES EISENDRATH, D. N. AND RoLNICK, H. C.: Urology. Philadelphia: J. B. Lippincott Co., 1938, 4th ed., p. 411 SEJOURNET, P.: Bull. et mem. Soc. d. Chirurgiens de Paris, 35: 101, 1944. WEssoN, M. B.: J. Urol., 52: 334--337, 1944. WESSON, M. B.: Urol & Cutan. Rev., 50: 16-19, 1946. YouNG, H. H. ANDDAvrs, D. M.: Young's Practice of Urology. Philadelphia:W. B. Saunders Co., 1926, p. 167.