摩托車交通事故造成陰囊外傷與睪丸鞘膜外露–病例報告

許程皓¹、蔡承翰^1,2
1臺北榮民總醫院泌尿部; ²國立陽明交通大學書田泌尿科學研究中心;

Scrotal Traumatic Injury with Exposed Tunica Vaginalis

caused by a Motorcycle Traffic Accident – A Case Report

Chen-Hao Hsu, M.D., M.T.M¹, Cheng-Han Tsai, M.D.^1,2

¹ Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan

² Department of Urology, School of Medicine, College of Medicine and Shu-Tien Urological
Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Introduction: Accounting for nearly two-thirds of genitourinary trauma cases, injuries to the male external genitalia result from a range of mechanisms, including both blunt and penetrating trauma. Given the potential impact on fertility and hormonal function, prompt surgical exploration and repair are often essential. In this case report, we present a young adult who required emergent scrotal exploratory surgery following a traumatic injury sustained in a motorcycle traffic accident.

Case presentation: A 21-year-old male with an unremarkable medical history was involved in a traffic accident, during which his motorcycle was struck from behind by a car. He was promptly transported to our emergency room (ER) via ambulance. Upon examination, multiple skin lacerations and abrasions were observed on various parts of his body, including the right temporal area and limbs. Furthermore, the scrotal injury revealed the exposed left side tunica vaginalis (Fig. 1). A bedside sonography was conducted, showing normal testicular blood flow without any signs of intra-testicular necrosis. A contrast-enhanced computed tomography (CT) scan of the abdomen indicated normal organ appearance, while highlighting a skin defect in the left perineum and left hemi-scrotum, without any evidence of contrast extravasation (Fig. 4-9).

The scrotal exploratory surgery was performed on the next day. Exposed left tunica vaginalis with ecchymosis was noted initially (Fig. 2). After linear dissection performed through the tunica vaginalis, the tunica albuginea with purplish appearance was then disclosed, which was favored to be the delayed hematoma (Fig. 3). There was no discontinuity or rupture of the tunica albuginea. Warm saline irrigation and soaking was applied, after discussing the possible risks of testis congestion, ischemia, future testis atrophy and infertility with his family, they expressed a strong preference for preserving the testis. Hence, layer-by-layer closure of the wound was done and a Penrose drainage tube was placed at the dependent portion of the wound.

A Doppler scrotal sonography was conducted two days after the surgery, revealing preserved perfusion of the bilateral testes and a 0.6 cm nodule at the left testis, which is suspicious of hematoma formation or tumor such as an epidermoid cyst (Fig. 10-12). The tumor markers including AFP, Beta-HCG and LDH were examined and were all within the normal limits. With minimal drainage of the Penrose tube, it was removed on the postoperative day five and the patient was discharged in stable condition. The follow-up Doppler scrotal sonography one month later showed normal echogenicity of the bilateral testes and a 0.2 cm nodule at the left testis, which was favored to be the previous hematoma decreasing in size.

Conclusion:

In this case of scrotal injury caused by a motorcycle traffic accident, the importance of timely and meticulous surgical intervention becomes evident, as highlighted by the follow-up Doppler scrotal sonography, which indicated preserved perfusion of testicular blood flow and a reduction in the size of the hematoma.