唐靖 何旻學 羅華安
國泰綜合醫院 外科部 泌尿科
Traumatic Rupture of Hydrocele: Case Report and Review of The Literature
Chin Tang, Min Shiue Ho, Wah-On Lo
Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
We present a case of a 39-year-old male with a history of hypertension, gall bladder stone, and gastric ulcer presented to our emergency department complaining left scrotal pain. According to his statement, he was diagnosed with a 9.3 cm left hydrocele at our urologic clinic about a year ago but didn’t undergo any treatment due to limited symptoms and the COVID-19 pandemic. On the day of presentation, as he was jogging, he accidently fell to the ground with his leg crossed, which cause squeeze and impingement of his left enlarged hemi-scrotum. Not only did he suffer immediate left scrotal pain, he also noticed that there were changes of the texture and appearance of his left hemi-scrotum, with previously more tense and smooth-surfaced, now soft and wrinkled. He was then brought to our emergency department where scrotal ultrasound was performed, which revealed a decompressed left hemi-scrotum with substantially decreased amount of fluid inside tunica vaginalis as compared to the image from a year ago, and some newly developed soft tissue densities around the testis. Under the impression of traumatic rupture of hydrocele with hematocele, immediate scrotal exploration with blood clot evacuation and hydrocelectomy were performed. The tunica albuginea remained intact and the rupture site of the tunica vaginalis was at the left lateral margin. The patient was discharged 2 days post-operatively without clinical sequala.Hydrocele is one the most common disease in the practice of urology. However, hydrocele rupture is a rare event with less than 10 cases reported in the literature. Therefore, diagnosis require a high level of suspicion and meticulous history taking and physical examination. Conservative treatments for hydrocele rupture have been attempted in recent reports with a shockingly high recurrence rate (>50%) that ultimately require surgical intervention. We present this case to share our experience of diagnosis and management of this peculiar disease.