交通事故後的雙側外傷性睪丸移位-罕見病例報告

徐明蔚、蔡禮賢

中國醫藥大學附設醫院 泌尿部

Bilateral traumatic testicular dislocation after traffic accident : a rare case report

Ming-Wei Hsu, Li-Hsien Tsai

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Abstract

Traumatic testicular dislocation, the abnormal position of testis outside scrotum, is an uncommon complication after traumatic scrotal injury, especially traffic accidents. It usually happens at the time of trauma and may coincide with other abdominal injury. The diagnosis relies on physical exam and imaging modalities including ultrasound and computed tomography. Early reposition saves testicular function and reduces malignant change. We will present a case with traumatic testicular dislocation treated successfully by surgical intervention.

This 33-year-old male without medical history presented to the emergency department with pelvic pain after a motorcycle collision. Physical exam revealed multiple abrasion wounds over the trunk, four limbs and prepuce. Computed tomography showed traumatic type B aortic dissection, pelvis open book fracture, bilateral distal radius fracture.  On the other hand, we identified bilateral testes located in the inguinal canal rather than scrotum, with surrounding air formation. Sonography revealed normal blood flow of bilateral testes.

He underwent percutaneous thoracic endovascular aortic repair (pTEVAR) for traumatic type B aortic dissection initially and was admitted to the intensive care unit for further care. One week later, we performed bilateral orchiopexy. During the operation, we made a transverse suprapubic incision and freed the testes from bilateral inguinal canal.  Bilateral testes were grossly healthy with intact tunica albuginea. Ultrasound also showed preserved blood flow of bilateral testes. We then open the scrotum through the midline and pull the testes to scrotum and fix them over dartos muscle. There is no complication related to testes after operation.

Conclusion

Bilateral traumatic testicular dislocation is a rare sequel of scrotal trauma. Early surgical intervention focuses on reposition and fixation of the testis and is the most efficient treatment option.